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Learning Center Experience
I honestly have no idea what I am supposed to do!” That
is what I thought as I sat in the assessment room alongside my psychology clinical
supervisor, a very competent-looking speech and language therapist, and a very,
very competent-looking occupational therapist. I mean, I knew how to administer
the assessments in theory, right? Now I
was in the room, ready to participate in my first interdisciplinary assessment
of a 3-year-old boy. No one told me that other people would be in the room
doing assessments at the same time. Certainly, I was not prepared for the fact
that the parents were behind a two-way mirror. Perhaps becoming a psychologist
was a bad idea. I really didn’t sign on to do all this in front of so many
people. Maybe I should just walk out…or die.
As a beginning therapist, I can remember many of these terror stricken
moments when all of my education and previous professional and life skills
seemed to fly out the window as I bowed under the scrutiny and pressure of my
training. It was in these moments that the chasm between what I learned and
what I could actually do seemed deep and wide. As I sat in the assessment room
of the autism clinic, wishing I could blend into the wall, watching an even
more scared 3 year old start to cry, rock, and flap his hands, I felt totally
My supervisor didn’t skip a beat. He walked over to
the boy and picked the boy up from the mat he had been standing on as the adults
in the room began to set out toys. My supervisor slowly walked around the room
with the boy in his arms, and with each step he gave a little bounce and clicked
his tongue. No words were exchanged, and we all watched as our little 3-year-old
friend started to bounce to the rhythm of the steps. After a while, my
supervisor put the child down. The boy lifted his arms and my supervisor took
the boy’s hands. The boy jerked back and my supervisor let go. Then, the boy
came back and held up his arms again. It was a game!
On cue, the occupational therapist and speech and
language pathologist joined in, repeating the same behavior with the boy a few
times. Then, the occupational therapist pulled out a small trampoline. Thus
began a well-orchestrated dance where the different assessments were administered
together, with one professional offering part of an assessment interspersed
with physical play, jumping and pulling. When the boy got tired of looking at
the items that one person presented, the next would step in and work on part of
his or her assessment. Assess, pull, jump, click, asses, pull, jump, click, and
On that day, I experienced rhythm in an “ah-ha”
moment that changed forever how I do what I do. I saw the possibility of the
value of a team; how standardized assessment can be administered in order, and
out of order at the same time; and how a little kiddo with autism can
communicate verbally and nonverbally, clearly and immediately, his needs if you
stop to ask. Our little friend, it turns out, had a high sensory threshold. He
needed a lot of physical input or feedback. All of that sensory information
helped him to feel relaxed. He didn’t want to talk—in fact he could hardly talk—but
he could laugh and hum and click his tongue. Between that and signing “more,”
he sent a message loud and clear about what he needed to stay in the room with
three strangers and one scared trainee stuffed in the corner.
Children with autism come to treatment providers of many
health and allied health
disciplines and we have to really understand how to communicate with children
and their families about their individual needs. We easily think to assess for
cognitive and educational needs. Check. Speech and language issues. Check. Co-occurring
disorders. Check. Other health issues. Check again! However, one thing that we
sometimes forget is the assessment for sensory needs and preferences. The funny
thing is that if we don’t look to see how a child best experiences input and
expresses his or her need to output, we really can’t expect any of our
interventions, that all involve input and output, to run very smoothly.
It is estimated that between 45 and 95 percent of children
with autism spectrum disorders present with some kind of sensory or perceptual
abnormality (Atlantic Provinces Special Education Authority [APSEA], 2013). This
means that even at the low end, approximately half of the children who come to
us for accurate assessment and diagnosis walk in the door with the need for us
to consider this issue. When we consider the importance of touch and how
automatically we use touch and other forms of nonverbal stimuli to communicate
with young children, we can envision the possible problems that we, as
practitioners, could create by over or under stimulating a child during the
We know that many children on the autism spectrum demonstrate
hyper-sensitivity to sounds, textures, or smells. Other children show hypo-sensitivity
and a diminished response to sensory input in their environment. Still other
children seek out sensations that fall in line with their stereotypic behavior (APSEA,
As I think back on that day, years ago, when I started on my
journey, I think of the pivotal moment where a kind and competent treatment
team, and a lovely 3 year-old-boy, reminded me that all kids have sensory
needs. Some of these needs are different than what we might expect or think of
as normal. This neither diminishes the need for nor excuses providers from
practicing awareness and gaining expertise so that we successfully find the
rhythm for each child’s assessment. Only then can we get these wonderful
families on the best path towards their future.
Atlantic Provinces Special Education Authority.
(2013). INFORMATION PAPER, Research to Inform Practice, Sensory Differences and
Autism Spectrum Disorder. Halifax, Nova Scotia.
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