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    Faculty Member and Psychologist Natasha Chung Talks About a Pivotal Career Moment

    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 helpless.

    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 so on…

    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 assessment process.

    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, 2013).

    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.


    Reference

    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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