I learned almost 30 years ago that my extremely fussy baby grew calmer when cocooned tightly inside my arms as we swayed side to side. Back then, I had not yet heard about his neurologically-based disorder known as Asperger’s syndrome (part of the autism spectrum), which is associated with sensory sensitivities and social and communication challenges. However, as an occupational therapist, I already understood how atypical responses to sensations impacted learning and motor development, specifically fine-motor abilities to touch, grasp, and manipulate objects.
My son developed very good hand skills, and he loves robotics. However, many children on the autism spectrum respond to sensations—what they see and feel—in ways that interfere with learning functional hand skills, such as closing buttons, cutting on a line, and writing. For example, a child might:
- Flap his/her hands and spin when entering a crowded cafeteria instead of opening lunch containers and eating
- Repeatedly open and close scissors or caps on a marker during art class
- Refuse to wash his/her hands or touch paint, glue, or other gooey substances
Children with autism often find repetitive behaviors calming. This is good! However, it is a problem when the child is unable to stop sifting sand through his fingers in order to learn the more advanced skills of shoveling sand into a pail or shaping it into a sphere. Repetitive hand motions called “stereotypies” can interfere with learning.
Hand activities, such as playing tug-of-war or building a snowman, provide deep, heavy pressure that stimulate muscles and joints. Children with autism often crave this type of stimulation, which is why my baby was calmed when held snuggly. It is also why children crash into cushions, sleep better when using a heavy blanket, and like having a heavy pet lay on top of them. Hand activities can also be chosen or adapted to provide deep pressure as children squeeze, pull, or push materials. This type of sensory stimulation helps them to engage, use their hands, and at the same time, decrease touch sensitivities.
Let’s First Adapt the Environment
Children with autism are often easily distracted. They may focus best when wearing ear covers that muffle sounds. Headphones or a sound system with soothing “white” noise or music may help to drown out distracting sounds. Consider using table lamps that shine directly onto materials rather than overhead lighting. Many children with autism are particularly sensitive to fluorescent lights. Offer seating or positioning options such as:
- Belly on the floor, leaning on forearms or over a bolster with hands, knees, and feet reaching the floor
- Standing or kneeling at a table
- Sitting in a rocker, glider chair, swing, or other movement apparatus or using a cushion that wiggles, bounces, or vibrates.
- Straddling a chair facing backwards enables a child to support her arms on the back of the chair
Explore which special, fun sensory experiences you can create that your child will associate with using his or her hands. Suggestions include:
- Smelling incense or other aromas
- Wearing a weighted lap bag or vest
- Chewing gum or sucking on a water bottle
- Sitting on a bean bag chair
- Using toys that light up while playing inside a darkened area
Keep these “special times” brief and the activities easy so that your child will be successful. Some children might prefer a visual timer or schedule so that they know when the activities will end. Then finish up with a sensory treat—perhaps time on a trampoline or rolling up inside a blanket.
Squeeze, Pull, and Push Adaptations
Squeeze toys may be purchased or homemade by filling a heavy-duty balloon with play dough. Knot the end and then insert inside a second balloon to make extra strong. I also make what I call “sensory socks.” These are made by filling socks with one or more of the following materials and then knotting or sewing the ends securely:
- Sand (put inside a plastic bag first if concerned about leaking)
- Pieces of foam, packing peanuts, bubble wrap
- Marbles, pennies, bells, or beads
Insertion Activities and Ring Stacks
The “sensory socks” can be pushed to fit through an opening in a large container lid (try a cat litter or detergent bucket). Make the hole small enough so that your child will need to use force to push the socks or other squeeze toys through. The “sensory socks” can be turned into “sensory rings” by sewing the open end of the sock over the toe end. Then these rings can be placed on a ring stack, used in tossing games or just carried inside the palms. Children who refuse to put their hands directly into sensory bins may better tolerate manipulating sensory socks and rings. Another simple-to-make, squeeze activity involves feeding the “Hungry Harry” ball. It is made by drawing a face on a tennis ball and cutting a slit for the mouth. The child squeezes the ball with one hand while feeding small items into its mouth with the other hand. The items, such as the pennies shown in the accompanying photo, can be pressed into a glob of putty so the child has to remove them from before feeding Harry.
Adapted shape sorters require using force to push the shapes through an opening. They can be made by cutting holes in detergent bottles or other plastic containers, making the holes small enough so that the objects must be pushed. Try cutting holes that enable your child to push:
- Small balls through a round opening
- Blocks through a square opening
- Dominos through rectangular openings
Many children love construction toys (such as LEGOs or TinkerToys) that require force to push and pull pieces together and apart. Stringing and lacing activities can be adapted to also require the child to push and pull by using thick strips of fabric instead of string. Tie knots along the fabric and attach colorful duct tape to the fabric’s tip so that it is easier to grasp. Children with coordination challenges will find it easier to string small rings instead of beads. I like to cut flat donut shapes out of plastic containers so that I can cut the hole size according to the child’s abilities. Tie a large ring to the bottom of the fabric so the small rings don’t fall off.
Many children love vibration and are more motivated to engage in fine-motor activities when materials shake. The sound also helps them to focus on what is in their hands. A battery operated pen or toothbrush can be used by:
- Placing it inside a shape sorter or insertion container
- Attaching it to the tip of fabric used for stringing
- Pushing it into the top of a ring stack made out of a tube or swimming noodle
These are just a few of the sensory adaptations that may motivate your child to engage in hand activities. Now it is time to get squeezing, pulling, and pushing!
Barbara Smith is an occupational therapist, author, and nationwide presenter of workshops and courses for both families and professionals. Her books include The Recycling Occupational Therapist and From Rattles to Writing: A Parent’s Guide to Hand Skills (published by Therapro, Inc. 2011). Barbara’s new book From Flapping to Function: A Parent’s Guide to Autism and Hand Skills (sold on Amazon) explains how autism impacts hand skill development and provides strategies that help children to reach their potentials.
Please visit her website at RecyclingOT.com, her blog at RecyclingOT.blogspot.com, and join her Facebook page, “The Recycling Occupational Therapist.”
This article was featured in Issue 55 – Celebrating with the People We Love