I have a clothing issue with my little one. Since Christmas, she has been wearing Peppa Pig shirts and dolphin shorts only. Her school requires her to wear a uniform, and I can’t get her to wear it. Has anyone experienced this with their child? Her therapist said it’s not sensory as the shirts she wears have different textures. I am so frustrated.
—Honey
Dear Honey,
Clothing challenges are a common issue among people with autism and hypersensitivity has more to do with the sensation of something against the skin than it does with sensitivity to only one type of texture or fabric.
I am not saying your child’s therapist is wrong, but I do think it’s worth considering a combination of sensory AND other factors.
Research tells us that approximately 90 percent of people with autism have sensory processing challenges (Baranek et. al, 2006; Schoen et. al 2009) and sensory over-responsivity is the most widely researched category of SPD. A person, regardless of whether they have autism or not, maybe hypersensitive to any sensation.
Avoiding certain fabrics or clothing may happen for a variety of reasons, but one of the most common for children with autism is because their sense of touch is over-responsive or hypersensitive. Our skin has different receptors and for simplicity’s sake, we can think of our skin as having a light touch and deep touch receptors.
When someone is hypersensitive to touch it is likely his/her “light touch” receptors are over-working. Deep touch receptors give what is considered “inhibitory” or calming input to the brain. When light touch receptors are working more than deep touch receptors the balance of sensation is off and a child may feel over-excited or overstimulated by whatever is causing the sensation; in this case clothing. Imagine the sensation of being tickled as you slide your arm into a sleeve; or worse, imagine sandpaper scraping your skin every time you move inside a shirt.
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It is important to know the current theory behind hypersensitivity is that it is a physical response caused by receptors in the skin over-firing or not working correctly OR it is because the physical feeling of the clothing against the skin is being processed or perceived differently in the brain of the child experiencing the problem. We are told people with touch sensitivities may feel physical pain from sensations that feel fine to neurotypical individuals.
Hypersensitivity is not something a person can control and when a child refuses to wear clothing because it “feels bad”, forcing him/her to do so can actually increase the negative sensation and is likely to cause greater upset, anxiety, and/or negative behaviors related to the situation.
Another reason a child with autism might not wear clothing is that he/she may have what is called “rigidity,” which is also very common among children with autism. Rigidity means not being flexible in your approach or in the way you do things or in the way you think. Wanting to wear the same clothes all the time may be considered a “rigid” or “repetitive” behavior. It is possible a child wants the same clothes or the same shoes, not because he/she is hypersensitive to the physical sensation but because he/she is hypersensitive to change.
There is recent research that shows brain differences related to sensory perception and rigidity among children with autism as compared to neurotypical children, which validates that there is likely a physical reason your child wants to stick with Peppa the Pig.
Some strategies that might encourage wearing of the school uniform include:
1) Offer deep touch pressure before your child gets dressed: massage, big hugs, and squeezing/pressing each limb gently with the flat palm of your hands or rubbing the skin gently with a loofah brush are all examples of things that might feel good to a child and help calm the skin IF in fact, touch hypersensitivity is an issue for him/her.
2) Warmth can be calming, and I have encouraged parents to try having the child sit for a few minutes before getting dressed, wrapped snugly in a warm towel or blanket…in the morning this can happen while eating breakfast or while brushing teeth.
3) There are companies that sell compression clothing which means the clothing fits snugly, thus offering deep touch pressure throughout the day. It may be more comfortable than loose clothing. Wearing an undershirt that offers deep touch pressure may help the uniform feel more comfortable. (Consider washing and re-washing the uniform to soften it and cut out any tags/labels that might rub against the skin; consider short-sleeved options vs. long-sleeved and request permission to wear the version more likely to be accepted by your child).
4) Gradually offer the uniform (non-preferred clothing items) well before the season change (i.e. during the last month of the summer or during every day of a brief school break). This allows the child to see the clothing repeatedly, feel it, and/or try it before the pressure to wear it sets back in, allowing the non-preferred clothing to remain a part of his/her everyday norm.
5) Avoid pressuring a child to wear something that isn’t comfortable but when necessary, offer choices such as “Where do you want to get dressed? In your bedroom or downstairs?”, “Do you want to put on your shirt first or your pants?”, and “Where should we put the Peppa Pig shirt so you can put it on as soon as you come home?”
6) Parents may be concerned about temperature regulation but sometimes children with sensory differences don’t feel temperature the way we would expect, so follow your child’s lead as to whether he/she is cold or hot as often as possible and as often as is safe to do so. Perhaps there is a Peppa Pig jacket, hat & gloves, or accessory that may be added AFTER the school uniform is on.
7) Find clothing similar in color and style but slightly different from the preferred clothing, i.e. it may have pockets and that’s the only difference or is the same color but a slightly different style. This is difficult to do with a school uniform but if the Peppa Pig shirt has short sleeves, then see if you can use a short-sleeve uniform top. If the Peppa Pig shirt is pink and the uniform shirt is blue, emphasize the “sameness”—” Look! I just realized Peppa Pig is on the front of the shirt and so is the name of your school.”
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This can be done with other parts of the uniform too: “Your dolphin shorts are shorts and so are these ones. I’m so glad you get to wear shorts to school.” This chaining of sensory elements of the clothing helps the child find some flexibility within his/her comfort zone and leads him/her toward more flexibility. Over time, pairing the two together might offer cues of similarity and familiarity to the child, making him/her more likely to interact with the clothing item.
8) Play games with the school uniform. Have him/her dress stuffed animals in it. Have your child carry it with him/her. Have him/her pack and unpack it into his/her drawer. If you have a Peppa Pig doll, perhaps the doll could try on the uniform. This will encourage him/her to feel it repeatedly, thus potentially de-sensitizing him/her to the novelty of the new item while pairing the uniform with Peppa Pig and/or fun.
One of the biggest reminders I give parents is to try NOT to do these things when under the time constraint of trying to get out the door. Pressure increases stress for everyone, which can increase rigid behaviors and hyper-sensitivities, resulting in the child’s need for more control. Your child does need to get dressed and does need to follow the rules of the school you’ve chosen so some upset is to be expected. It’s how he/she is supported in managing and working through that upset that is important.
I hope this is helpful to you.
This article was featured in Issue 100 – Best Tools And Strategies For Autism
