Sensory Profiles, Person-Environment ‘Fit,' and Autism

DSM-5-TR diagnostic criteria for autism include hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment. Some neurodevelopmentally atypical people and clinicians who work with them prefer terms such as sensory over-responsivity or sensory under-responsivity (a more strengths-based view), sensory craving or sensory seeking, and sensory defensiveness (these better capture autistic experience). But terms aside, what does atypical responsivity to sensory input mean in real life?

Everyone's Sensory Profile 'Fits' Some Environments Better Than Others

Each one of us, each moment of our lives, takes in, processes, and responds to sensory information from our external and internal (bodily sensations and feelings) worlds.

Everybody, neurotypical and neurodivergent, can be viewed as having their own unique sensory profile, or set of relatively weak and strong abilities to sense and then process sensations into perceptions, and then react or respond.

Our sensory systems do not function in isolation from each other. Our brains and nervous systems constantly take in, integrate, and act on information from multiple sensory systems. Occupational therapists in particular use terms like sensory integration and sensory integration disorder.

Each person’s sensory profile ‘fits’ better in some environments and situations than others. Every one of us also strives to get our sensory systems (vision, hearing, touch, smell, taste, proprioception, vestibular, interoception) to work in or adapt to environments and situations they do not fit well.

When our sensory profile is not a good ‘fit’ for an environment or experience, we sense-perceive-respond more slowly and deliberately (which is exhausting) and less adaptively. Some people may even withdraw, melt down, or seek soothing sensory experiences. This may be especially true of people diagnosed with autism.

Sensory Profiles and Autism

Some neurodivergent people, including people diagnosed with autism, may experience sensory over- and/or under-responsivity, sensory seeking, and/or sensory defensiveness but mask or camouflage so well that there are no observable behavioral manifestations. They may, though, experience discomfort, distraction, depletion, irritability, or rage—the origins and functions of which may be misinterpreted or misunderstood by the person and/or others

Boys and men may be more likely to show behavioral manifestations and be identified earlier and more often (i.e., by parents or teachers) than girls and women because, in general, males tend to externalize more while females tend to internalize more and may do more to mask or camouflage.

Sensory differences impact social interactions. Social interactions may be avoided, or the person with sensory difference-related reactions may be avoided by others. Sensory differences during social interactions can be distracting (similar to how social anxiety makes it harder for people to attend and quickly respond during social interactions) and cognitively depleting—exhausting.

Neurodivergent sensory systems can also be strengths (e.g., attention to detail, seeing or hearing things most do not hear or see, noting different perspectives than most others, musicians, artists, etc.).

Behaviors That May Indicate Sensory Issues (and Neurodivergence or Autism)

These are some of the signs and symptoms I look and listen for when I first meet new patients in my practice:

• Meltdowns, avoidance-withdrawal, cognitive depletion-exhaustion, especially in particular settings/situations/times of day
• Overwhelm in crowds (e.g., school hallways, city streets, shopping malls)
• Aversions to specific sounds, lights, textures, touch, smells, and food (e.g., people chewing, fluorescent lights, clothing seams or tags, firm or light touch, soap and other personal hygiene products)
• Restricted food choices and/or seeming lack of awareness of hunger or thirst
• Excessive and/or repetitive smelling or touching or unusual sensory exploration (e.g., licking people or objects)
• Unusually close visual inspection of objects, fascination with visual repetitive movement (e.g., fans, doors)
• Frequently chewing or sucking on sleeves or collars, strong attraction to a particular texture or other tactile input (e.g., deep pressure or a weighted blanket)

Note: This is not a comprehensive list.

Two Unique and Illustrative Sensory Challenges That May Be More Common in Autistic People

Misophonia is an extreme reaction to common sounds that most people don’t even notice. The most frequent triggers are noises related to eating and breathing. Reactions can include aggression or an intense need to escape. Individuals who experience sensory differences usually have good insight and explain their reactions as stemming from their own sensory differences. People with misophonia may believe others are acting to intentionally irritate them and react with blame and anger.

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How to Find Your Sensory Goldilocks: Achieving the "Just Right" Fit

Alexithymia is a neurological phenomenon in which people struggle to identify, label, and then communicate their emotions (e.g., anxiety, sadness, anger, shame). This may be connected to interoceptive sensory system issues. One young adult patient told me, “I know how I am supposed to feel when (x or y or z) happens, and so I can say I 'feel' that way, but I really don’t feel anything." Imagine how hard it is to learn emotional self-regulation strategies and techniques when one can’t identify one’s own emotions.

Some Accommodations and Adaptations

I invite you to experiment with these—or encourage your child, partner, family member, or friend with sensory issues to experiment with these—and see what happens (it can be hard to know ahead of time what may help). Note that this is not a complete list.

• Frequent breaks (removal from sensory stimulation) and/or sensory breaks (physical activity or deep pressure) and/or allowing movement. An adult patient's employer allows her to go sit in her car during the work day as needed. One of my child patients leaves class to roll on a gym mat or large ball multiple times a day. Another child is allowed to stand or walk back and forth in the back of the classroom as needed.
• Limiting auditory or visual stimuli. For example, taking a test in a quiet room or placing dividers between desks. Alternatively (for some), working with music or the radio on. Headphones or noise-cancelling earbuds.
• A fidget toy, squishy ball, piece of cloth with a preferred texture, or a stuffed animal with a preferred feel or smell.
• Allowing (rather than discouraging), when possible, "stimming" or repetitive vocalizations or behaviors, such as rocking back and forth or "flapping" hands while standing or walking around.

For another option, pay attention to what you or your child or family member or partner or friend with sensory issues is already doing, at least at times and with at least partial success, to manage sensory issues, and perhaps do more of it.

To find a therapist, visit the Psychology Today Therapy Directory.