Use of Assistive Technology to Address the Overwhelming Sensory Stimuli in Individuals with Autism Spectrum Disorder
The use of assistive technology as a tool for individuals with autism spectrum disorder has greatly increased over the past decade. Individuals with autism experience difficulties in sensory processing and innovative technologies have proven to be a great tool to address overwhelming sensory stimuli by providing a sensation of relaxation and calming effects. The purpose of this paper is to provide a brief introduction to assistive technology and autism and investigate how different assistive technology such as pressure vests, the squeeze machine and snoezelen rooms have been instrumental providing relief to individuals with autism in stressful situations. The objective of this paper is to educate people of the usefulness of assistive technology to increase participation of individuals with autism spectrum disorder.
Assistive technology is devices that help an individual with a disability on any spectrum perform certain tasks that are considered difficult or impossible for them otherwise. Such technologies enable people with disability to complete everyday tasks in less time and without assistance from other people. Be it a young kid at preschool or a working adult at workplace, assistive technology has enabled these individuals to gain a sense of independence, and increase their participation in any task they perform. Today, assistive technology has become a major part of the schools and education curriculum to help individuals with a disability succeed in academics and gain necessary life skills. Schools use these assistive learning tools to evaluate the efficiency of these devices, monitor the performance and progress of students, thereby creating a better learning experience for an individual with disabilities.
Assistive technology can be classified into two categories: low-tech assistive technology and high-tech assistive technology. A low tech assistive technology device is simple in nature, passive, and very few moving parts. They are usually inexpensive, easy to operate and don’t require much training to use. High tech assistive technology device, on the other hand, is considered to be more complex with an electronic component that takes some time for the user to adapt to and use efficiently. However, while selecting an assistive technology, it is important to note that one size does not fit all, and therefore depends on the user’s abilities, needs, and necessity in being able to increase functionality.
Previously, there was a heavy emphasis on the use of assistive technology for people with physical disabilities. However, in the past few decades, Autism has emerged as an important area for the use of assistive technology. Technological interventions have helped in important skills development, allowing an individual with Autism to actively progress in performing their everyday tasks. Designers, developers, and innovators all have started integrating interactive technology as a tool to help people with Autism. However, in order to better understand how advancement in assistive technology has led to increase, maintain and improve functional abilities of people, we first need to understand what autism is and how affects different individuals.
Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is present in an individual since early childhood, caused by different permutations of genetic and environmental influences. There is a wide range of severity in the way it affects different individuals, therefore some people can be mildly impaired while others are severely impaired by their symptoms (as shown in Figure 1 published by the Department of Health, Child Assessment Service). When an individual is referred to be Autistic, they are presumed to be severely disabled on the autism spectrum. Individuals with ASD have difficulty in communicating and interacting with others, making it difficult to express their needs and wants to another individual. They show social differences beginning in early childhood where they are unable to maintain eye contact, find it difficult to form and maintain any sort of relationship with another individual as well as miss out on social cues. But most importantly, individuals with ASD are known to have difficulty with sensory integration that makes them overactive or under-reactive to sensory stimulation.
Up to 96% of children with ASD find it difficult to process and integrate to sensory stimuli. Often times due to over- or under- reactive sensory stimuli, these individuals may ignore the people speaking to them and may even be mistaken to be deaf. On the other hand, however, they may also get easily agitated to the softest sounds. If they get upset to sudden noises, they may respond by blocking their ears or making repetitive sounds in an attempt to stop the external stimuli. Sensory integration techniques, such as deep touch pressure, can promote attention and awareness, allowing them to reduce overall stimulation.
Higher functioning children who have autism generally perform as well as peers until the sixth-grade level when typical learning involves interpretive and abstract skills. When these skills are emphasized, higher functioning children who have autism fall behind their peers in school (Venter, Lord, & Shoppler, 1992). Children who have autism have deficits in developing communicative language. They tend to grant, pull, and point or instrumentally touch to communicate their needs. It is extremely rare for a child who has autism to develop language if he has not done so by the age of 6 (Rogers & DiLalla, 1990).
Sensory issues are very unique to an individual. An individual with autism finds it hard to distinguish one sensory feedback from another, and their brain takes in all the sensory feedback information at the same time making it an extremely painful experience leading to a temper tantrum. As soon as they enter a new environment or a changed environment, he or she suffers from a sensory overload that results in a painful experience. Individuals can take help of assistive and adaptive technology to alleviate these painful experiences.
Deep pressure therapy
Deep touch therapy refers to a form of tactile stimulation by exerting pressure on the surface in forms of “touching, holding, stroking, petting of animals, or swaddling” as described by Temple Grandin, one of the top scientists in the field of autism and animal science, in her research journal “Calming Effects of Deep Touch Pressure in Patients with Autistic Disorder, College Students, and Animals”. She goes on elaborate that “occupational therapists have observed that a very light touch alerts the nervous system, but deep pressure is [relatively more] relaxing and calming”. Research in deep touch pressure has illustrated that children with ASD seek and prefer firm surface pressure instead of a distal simulation of hearing and seeing (Kootz et al. 1981). For example, young children with ASD who are not receptive to the sensation of touch have “reduced self-injurious behavior and self-stimulation” through the use of deep pressure therapy. This application of tactile stimulation has been incorporated with several tools of therapy that include pressure vests, squeeze machine and snoezelen rooms that we will discuss next.
Children with autism are recommended to use sensory integration (SI) therapy starting at an early age. “Green et. al. reported that 38.2% of children with autism were currently receiving SI and 33.2% had received it in the past” (Stephenson and Carter, 1). The reason why therapist uses SI is that they believe that a range of problem that children with autism face every day may be due to “over- or under-sensitivity to sensor input” that a pressure vest can help alleviate. A pressure vest consists of a torso-hugging suit that an individual with autism wears to recuperate from issues such as insufficient attention, hyperactivity etc. (Stephenson and Carter). A pressure vest is believed to provide an individual with “deep pressure stimulation” that induces a relaxing effect on the central nervous system, and thus, in the process, reduce sensory overload.
Children with autism can suffer anxiety from sensory overload, but an inflatable vest offers a “hug” of deep pressure to help keep them calm. The pressure from the Squease Vest, by the British company Squease, can be regulated by the wearer with the help of a hand pump, that inflates the vest with compressed air and doesn’t hinder their movement. Unlike the traditional weighted vest, squeeze or pressure vest also camouflages into a regular jacket of the child allowing him to wear it throughout the day without any problem. This kind of pressure vest also helps provide the child with a sense of confidence in performing their everyday tasks.
However, after several studies and inconsistent results, pressured vest are not clinically advised for individuals with autism. Stephenson and Carter further elaborate that although the results were mostly positive in providing relief to kids under research supervision, they believed that the change of environment could also result to the change in behavior instead of just the pressure vests.
The market price for Squeeze Vest, one of the popular pressure and weighted vests, can go up to $400, making it quite a pricey investment for families looking to invest in one for their child.
The Squeeze Machine
To investigate the effects of deep pressure stimulation, Temple Grandin designed a V-shaped structure with foam rubber padding in the inside to apply even pressure from both side of the individuals. The V-shaped structure was designed to cover the body from head to toe, with a foam-padded headrest for the individual to support their neck. “When the neck opening closes around the neck, it enhances the feeling of being surrounded and contained by the embrace of the deep touch pressure squeeze” (Grandin 65), allowing the user to control their amount of pressure applied. The principle on which the squeeze machine operates is the exertion of a great amount of pressure evenly distributed over the entire body.
Grandin described the incentive for her to build the squeeze machine was to “reduce the oversensitivity of [her] nervous system” to alleviate anxiety and help her calm down during a panic attack. After performing her study by testing the squeeze machine on college students she was able to determine that the machine had a relaxing effect on many individuals. Although the statistics of the study claimed that the machine worked well for 45% (18/40) of the participating students, 40% of the subjects did not have any effect on them.
Grandin argues that although the squeeze machine may be helpful for one individual, it will not necessarily work for other individuals. Nonetheless, it is a very well-known treatment, especially for individuals who are oversensitive to tactile stimulation. She mentions that root cause for this problem is “perhaps due to structural abnormalities in lobules V, VI and VII of the vermis of cerebellum observe in patients with autism” (Grandin 70), but the squeeze machine still requires extensive clinical evaluation even though her study shows that the observation has been quite encouraging.
The squeeze machine costs around $2000, which is very expensive for most families to afford one for their child’s deep pressure therapy.
Snoezelen Rooms are multi-sensory environments designed for children with autism that enables them to “select and receive sensory input in the type and amount he or she desires” (Kaplan et al.). Unlike pressure vests and the squeeze machine, snoezelen room creates an entire therapeutic environment for individuals to experience high levels of stimuli. It uses different sensations of light effects, sounds, smells, colors, textures, etc to generate a relaxing environment to alleviate anxiety and encourage communication and interaction. Studies on snoezelen intervention to address sensory stimuli have shown that it can decrease self-stimulatory and injurious behavior, and increasing interaction and participation.
While studying the effects of Snoezelen room on the behavior of three different individuals with autism, Kaplan et al. made the following observation:
“during Snoezelen based occupational therapy treatment sessions for three people with moderate to severe/profound intellectual disability, autism and severe challenging behaviors, carried over beyond the session to two different settings: increases in engagement with tasks immediately following the treatment sessions as well as to reducing the frequencies of challenging behaviors on the days after treatment sessions” (Kaplan et al., Conclusion)
Based on this information they further elaborate by saying that although these changes are relatively short-lived, however, the beneficial effects of the snoezelen room can be maximized by a repetitive session on a daily basis. The conclusion of the study also indicate that this sensory integration was effective in creating a calm and serene environment for some individuals, but not necessarily for everyone.
Creating a snoezelen therapy room can cost a fortune as it can cost averaging approximately $25000, something not every individual can afford. Furthermore, this cost does not include maintenance fee that can cost at least a thousand dollars, this restricting this treatment for people from a financially insufficient background.
Future Assistive Technology Tools
There has been a huge increase in the development of assistive technology tools for individuals with autism. Although new and emerging tools such as Virtual Reality is not necessarily targeting sensory integration, they have been playing an instrumental role in teaching communicative and social skills necessary for their adaptation. Scientific research by leading neuroscientist such as Dr. Daniel Yang, who has been studying an application of virtual reality in autism, has proven remarkable improvement in individuals social understanding and behavior (Virtual Reality Training Improves Social Skills and Brain Activity). People are now using virtual reality tools in combination with physical computing to provide individuals with autism sensory integration to help them relax and communicate better, helping them gain a sense of independence.
One Size Fits All
After carefully understanding and analyzing different assistive technology tools for individuals with autism we can say that while one type of technology may work for some individuals with autism, it may not necessarily work for other individuals. This insight helps us to further argue that the ‘One-size-fits-all’ methodology cannot be used while creating or using assistive technology. Everyone individual has a different response to their treatment and therefore cannot be assumed to be beneficial for all.
Today, this has particularly become an issue as parents use complementary and alternative treatments, under the influence of celebrity profiles or their online research, in addition to the traditional evidence-based, clinically approved treatment methods. Furthermore, these alternative treatments may include investing in latest assistive technologies that may include new wearable devices or sensory integration tool similar to snoezelen room, that not only is a huge investment but also not clinically approved to be a fail-proof treatment. It is important to note that since one possible treatment may not necessarily work for everyone, parents should work with the occupational therapists, researchers and clinicians to make informed decisions instead of pressuring them to do as what they think may be beneficial instead. While it is understandable what influences the thought process of the individuals, they need to work with the doctors to make a smart decision for their child (Bauer and Roberts, Scientific American).
This paper allowed us to gain a better understanding of what assistive technology and autism is, in context of each other, and elaborates on different assistive technology tools that are popularly used today to address overwhelming sensory stimuli for people with autism spectrum disorder. We used the scientific reasoning and research on how these different assistive technology tools have been successful in sensory integration, in one way or other. We also observed that these tools are not necessarily clinically approved, but have been an important part of helping individuals relax and calm down in stressful situations. We also noticed that the ‘one-size-fits-all’ methodology does not work in designing, diagnosing and implementing assistive technology. Our research also indicated that these assistive technologies are very pricey and not affordable for all, and limiting them to a certain demographic based on their financial standing limits the reach of its benefits. There has been a huge wave of using new and current media to improve social and communicative skills, and people are using physical computing in combination with virtual reality to create a better sensory integration for individuals with autism spectrum disorder.
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