Journeys with Autism

Today, I met with my OT to discuss the results of my sensory assessment. Her report was full of very helpful information. Things that have mystified me all my life began to make sense. 

I’ll share the highlights.

Here is a list of the assessment tools she used:

Interview
Developmental/Sensory History Questionnaire
Adolescent/Adult Sensory Profile (Brown & Dunn)
Quick Neurological Screening Test-II (QNST-II)
Gravitational Insecurity Screening Tool (May-Benson, AJOT 2007)
Subtests from: PEERAMID-2 (Levine)
Ocular Motor Control Screening
Clinical Observations of gross motor, fine motor, and balance skills

In her report, she defined a number of terms that were helpful in understanding how my sensory processing system works. I’ll use her definitions as I discuss how they relate to my particular situation.

Sensory Processing
“Sensory processing is the continual process of the brain filtering, interpreting and organizing sensory information from the environment and from our body. We use this information to determine what is going on in our environment (external stimuli) and in our body (internal stimuli) and how to respond in just the right way for the situation. When effective, we can filter and prioritize incoming information and determine if it should be noticed or disregarded and respond in an adaptive, purposeful manner.”

Needless to say, I have difficulties with “filtering, interpreting, and organizing sensory information.”

Sensory Processing Disorder and Sensory Modulation Disorder
“Sensory Processing Disorder (SPD) is the impaired ability to interpret, organize and make sense of various simultaneous sensations entering the brain. The brain may not filter the stimuli or it may misinterpret the stimuli resulting in various reactions including fight, flight, freeze and/or fright responses. Sensory processing disorders have subtypes: sensory modulation disorder (sensory over and under responsive types and sensory seeking), sensory discrimination, and sensory-based motor disorders.” (Note: SPD is not yet an official diagnosis, though many OTs are working very hard to make sure that it appears in the DSM-V.)

“Sensory modulation refers to one’s responses to stimuli. When one is not able to regulate the intensity and types of responses to stimuli (internal or external), this is called a sensory modulation disorder. One may over respond, under respond to stimuli and/or seek stimuli.”

The assessment shows that I have sensory modulation disorder of the sensory over-responsivity (SOR) type. In other words, my nervous system is highly sensitive to visual, auditory, and tactile stimuli, as well as to movement. No surprises there.

Dyspraxia
Dyspraxia is “a deficit in the ability to plan, sequence, and execute a novel motor task.”

The evaluation concludes that I have mild dyspraxia when doing fine motor tasks, such as knitting, and that I have moderate dyspraxia when doing gross motor tasks, such as karate.

To learn to knit, I used the instructions in a beginner’s knitting book. I found it difficult to figure out from the drawings how to hold the needles, how to place the yarn on them, and how to do the various stitches. It was hard to translate from the picture in the book to what was happening in my hands. Fortunately, I am a tenacious person, so I just kept reading the instructions and trying each task until I got the desired result.

Once I’ve learned a skill, I can repeat it. I sometimes get out of practice, but after a few tries and mistakes, I generally remember what to do.

As far as learning karate goes, I had a somewhat more difficult time. Fortunately, I learned karate from some very patient senseis who respected the way that I figure things out. For example, I was not able to learn a kata (a sequence of moves) just by watching and copying my sensei, as most people did. The process I used was comparable to the one I use to translate visual information from a picture book. I learned the katas by doing the following tasks:

1. Film someone doing the kata (or buy a video if I felt too shy to ask).

2. Watch the video at home and write down all the steps in sequence in a list.

3. Create a mnemonic for remembering when certain sequences are repeated or changed.

4. Diagram the directions in which I needed to move on a piece of paper, with items in the dojo noted so that I could orient myself properly. (All katas require that you face in each of the four directions. Sometimes sequences are repeated in each direction, sometimes sequences are slightly altered, and sometimes, new sequences are added.)

5. Practice the form at home while imagining that I was in the dojo.

When my sensei asked me to perform the kata while facing in a direction different from the one I had in my mind, I quietly panicked. For example, if when I practiced a kata, I imagined beginning the form by facing the window, I would become very agitated if my sensei asked me to demonstrate the form by starting in the direction of the door. Sometimes, I could do it, but it took a lot of practice to get the kata in my muscle memory, and I never lost my anxiety about having to begin in a different direction.

Gravitational Insecurity
From our discussion today, I learned that gravitational insecurity denotes a condition in which one cannot determine where one’s head is in relation to the earth. A person with gravitational insecurity is afraid of having his or her feet off the ground, and of having his or her head tipped backward. 

The evaluation concludes that I have severe gravitational insecurity, and that I rely to a very great extent on my vision to orient myself in space. I am particularly averse to any kind of rotational movement. I’ll let the report speak for itself here:

“A gravitational insecurity assessment was administered. She attempted and completed the following tasks: jumping, jumping over a line, swinging laterally on a platform swing, rocking herself laterally on a peanut-shaped physioball, stepping on and off a tilt board with little hesitation or cues and little to no emotional responses. Rachel quickly becomes dizzy when she stands on a chair and jumps from a chair with her eyes closed, and attempts to stand in tandem with her eyes closed. She was able to lie supine on a physioball and look up at the ceiling for a moment before needing to kneel and then lie on the floor due to severe dizziness. A weighted blanket was placed over her for 4 minutes as a grounding technique so that she could recover from this severe dizziness. Rachel stated that she became “nauseous” watching this therapist demonstrate rolling prone on the physioball and this task was omitted from the assessment assuming that her response would be aversive.”

Yes, I got nauseous just watching the OT tip her head backward!

Understanding the concept of gravitational insecurity explains a world of difficulties I’ve had with very simple tasks. For example, I generally resist any activity that entails having to move up or down, because when my head is in motion, I have a very difficult time orienting myself as to where the ground is. So, for example, I don’t like swinging up and down on a playground swing, but I can swing from side to side on a swing that I can stand on. When I swing from side to side, my head is in the same plane with the rest of my body and my feet do not move up or down.

Another example: As I write this post, the sun is going down, and I am going to have to get up and turn the light on. There are actually times when I sit here in the dark, using only the light from my screen to read the keys, because getting over to the light switch feels like such a production. I’m sitting on a futon on the floor, and the light switch is on the wall to my left, about two feet away. I can’t reach it from where I am, so my usual strategy is to move over toward it along the futon, staying in a sitting position, with my head remaining as still as possible. I then try to reach the light switch without getting up. It’s physically impossible for me to reach it from a sitting position, but that doesn’t stop me from trying. Because I’m writing about it right now, I’m conscious of the impossibility factor, and I’m aware that I’m going to have to find some other way to turn the light switch on.

Excuse me for a moment……

There, now it’s on. Guess how I did it? I carefully moved over onto my knees, raised my arm up, turned on the light, and then returned to a sitting position with a feeling of great relief. The entire time, my head remained in the same plane as the rest of my body. I made sure of it.