Part 1: Supporting Autistic Clients’ Sensory Systems – The Heart of Effective Clinical Work
Sensory sensitivities are common in neurodivergent people and shape their lived experience in countless ways, from mood, communication, relationships, and work, to wellbeing, resiliency and trauma. Yet, this crucial aspect of neurodivergent wiring is often misunderstood and overlooked by providers and society at large. As a neurodiversity-affirming practitioner, it is essential to be educated on this topic and sensitive to the ways it shows up in your work with autistic clients.
The topic of sensory sensitivities is so important to your clinical work with autistic clients that I decided to write this two-part blog series to provide you with in-depth knowledge and strategies to use immediately with your clients’ to better support their sensory systems and wellbeing.
In Part #1 of this blog post we delve into five tips to support your clients’ uniquely wired sensory system.
TIP #1: Learn about their sensory sensitivities and triggers that lead to sensory overload
TIP #2: Honor stillness and quiet as a coping strategy to reduce sensory overload
TIP #3: Develop “Sensory Soothing Plans” to self-regulate before, during, and after a sensory challenging situation
TIP #4: Reconnect to stimming as a natural, innate self-regulation strategy
TIP #5: Identify the role that masking plays in sensory overload, and safe ways to unmask
TIP #1: Build Self-Awareness of Sensory Sensitivities and Triggers
Sensory sensitivities refer to an individual’s heightened or lowered response (hyper- or hypo-sensitivity) to different sensory stimuli, such as sound, touch, taste, smell, and vision. Because a little sensory input can feel like a LOT of input to neurodivergent nervous systems, feelings of overwhelm can be commonplace. A simple grocery run for a neurotypical person can feel nerve-racking for a neurodivergent person because they feel bombarded by sensory input! My autistic clients have described the multitude of high-pitched noises, bright or flashing lights, strong smells, and chaos of other people around them as being “too much”.
Not only can sensations feel “too much”, they can feel incredibly painful. For instance, the buzz or flickering of a light bulb, which neurotypicals don’t even register, can feel incredibly agitating for some neurodivergent people but even painful for others. From clients, I’ve heard it likened to feeling like someone is poking their brain with a red hot fork.
These daily sensory assaults add up and can lead a client to experience a host of challenges including:
- Meltdown (ex: uncontrollable crying or angry outburst)
- Shutdown (ex: dissociation or “going nonverbal”)
- Autistic Burnout (ex: extreme exhaustion that leads to regression in skills, inability to function, or needing to take a leave of absence from work or school).
As a practitioner, it is important to help your clients become aware of triggers that lead to sensory overload so they can find ways to support their sensory system and wellbeing. Clients may benefit from you reviewing each sense one at a time to identify sensory input that feels overstimulating for that sense. For example, you might explore their hypersensitivities around touch. They might find certain textures of clothes or tags in clothes too scratchy. Helping them find clothes that are felt as neutral to their sensory system or even soothing (e.g., soft fluffy sweater) is key to reducing sensory overload. In addition to hypersensitivities, it’s common for autistic clients to have hyposensitivities. For instance, if they are hyposensitive to pressure, like me, they need more pressure to feel regulated and calm, such as from a weighted blanket.
As a provider you are likely to encounter clients with sensory sensitivities, as they are common in autistics, highly sensitive persons (HSP), AuDHDers (autistic + ADHD), and other neurodivergent profiles. It can be especially hard to appreciate how challenging a neurodivergent person’s everyday life is if you’re neurotypical and have no experience with intense sensory sensitivities. As a neurodivergent therapist, I have my own sensory sensitivities, but that doesn’t mean my experiences will perfectly match that of my clients. That’s why, whether you are neurotypical or neurodivergent, educating yourself on this topic is crucial so that you can effectively support your neurodivergent clients.
Sensory Sensitivities are Not the Problem
Now, let’s clarify that the sensory sensitivities or having sensory sensitivities is not the problem. It is a natural aspect of one’s neurology and can even have certain advantages, such as being more attuned to specific details or having an ear for music. Rather, the problem is mostly that neurodivergent sensory needs are not recognized, honored, or accommodated by society. Sensory sensitivities are not known, or talked about. The primary message neurodivergent people hear about their sensory systems is that there is something wrong with them; they are the problem. As a therapist, doctor, life coach, EF coach, or any other helping professional, being aware that sensory sensitivities can be a pivotal factor in your clients’ experiences can make all the difference.
Underlying clients’ challenges often is a sensory sensitivity. Digging back far enough to the root of your client’s concerns can uncover a sensory sensitivity that was never addressed or accommodated before. This may have led to avoidance, distress, or masking that ultimately impacted their daily functioning. Being aware enough to not lose sight of their sensitivities and having them at the front of your mind when working with clients is crucial in providing effective support and guidance.
TIP#2: The World is Overstimulating, Stillness is Needed
Honestly, autistic people, and other neurospicy individuals, are constantly having their senses attacked by the world. There is so much stimulation coming from all different directions all at once, and it can be overwhelming for them to navigate. At some point their nervous system can’t take anymore and they may have a meltdown or dissociate. A meltdown might look like yelling, throwing themselves down on the ground and thrashing around or punching a wall. Even though this helps them release the buildup of intense energy, society finds it unacceptable.
Most autistic clients have a story of being judged and shamed for melting down in public, and so they carry great fear this will happen again and intense embarrassment and shame when it does happen. Many autistic adults learn to dissociate to escape feelings of overwhelm and avoid the judgment that comes from a meltdown. As a practitioner, it’s important to understand your clients’ challenges and deep-seated fears around sensory overwhelm, and to help them find effective self-regulation strategies. Strategies to help your client connect with stillness can be essential.
Because of frequent sensory overload, stillness is often really important for neurodivergent clients’ systems. In therapy, with your support, they can achieve this sense of calm and inner stillness whether it’s through a mindfulness exercise or just sitting with you quietly without any demands or pressure. Just allowing them to feel your presence whilst you being open, accepting, radiating warmth and not saying a thing. It becomes more about them finding safe space to be, rather than having to do something for you or adhere to an agenda. It’s really powerful to be able to do that with your client. So, don’t underestimate that.
TIP#3: Sensory Soothing Plans
Often, neurodivergent clients I work with talk about overwhelm happening suddenly and unexpectedly. They might be mystified as to why it happened. It can seem unpredictable, leaving them feeling out of control and anxious. The factors that lead to overwhelm can be many. Overload can come from sensory, emotional, social and cognitive factors. Commonly, overload can trigger shutdowns or meltdowns, making it hard for a neurodivergent person to function.
A big part of the work you may do with autistic clients is to: (1) Support them in gaining awareness of the factors that contribute to overwhelm, and (2) Help them develop their own “Sensory Soothing Plans” to prevent and manage overwhelm. Niamh Garvey, an autistic author, provides insightful suggestions for Sensory Soothing Plans in her self-help book, “Looking After Your Autistic Self – A Personalised Self-Care Approach to Managing Your Sensory and Emotional Well-Being”. Niamh wrote, “If I am engaging in an activity that I know will challenge my sensory system, I make my Sensory Soothing Plan before I go. The bigger the event, the bigger the plan.”
Before entering a challenging sensory situation, some clients may find it useful to develop a Sensory Soothing Plan to help them before or during the situation (which I call a pre-plan) and a plan to help them soothe and regulate their sensory system after the situation (post-plan). For instance, maybe the situation involves going out to a restaurant to meet up with a family member or friend. The pre-plan might involve going to a small restaurant and sitting outside where there is no music and it’s less loud, and the natural lighting feels better to their nervous system. The post-plan might be to go home and read a book in a quiet room for an hour to reduce stimulation, and help their sensory system recalibrate.
A Larger Sensory Soothing Plan
This is for a situation that is expected to entail a large amount of stimulation that could likely lead to sensory overload. Perhaps the situation involves going to a large event, like a big birthday party, or multi-day event, like a work trip. The pre-plan might involve preparing meals for a couple of days and cleaning up the house before they go to the event so they won’t have to deal with these responsibilities upon their return. Also, the pre-plan might involve bringing noise canceling earbuds to the event, a hat to block out the lighting, and awareness to take bathroom breaks regularly for respite. The post-plan might involve resting at home in low lighting, spending quality time with their pet, with low demands for 48 hours after the event.
Your Autistic Client is the Expert on What They Find Self-Soothing
Collaborate with your clients on developing Sensory Soothing Plans to meet their needs. Sensory soothing plans help a client before or after an event to calm their sensory system and reduce anxiety and distress. Each client is unique, and they face many different types of stressors, so they will need to tailor their plan to the specific situation. Your client is the expert on their lived experience, so you need to trust that they know what soothes their system. As a provider, what you can offer is suggestions about different types of soothing activities, but ultimately your client needs to decide what works best for them.
TIP #4: Support Stimming as a Natural Coping Strategy
Stimming, or self-stimulatory behavior, is also something that neurodivergent individuals may engage in to cope with sensory overload and seek comfort. The wiring of their brain is different and stimming can help them self-regulate their system, calm it and their body down and release any tension built up. It can look like a variety of things such as rocking back and forth, jumping, repeating words or phrases, or hand flapping.
Stimming is a crucial and natural response that can do a lot for autistic people to help manage the intensity of their emotions, such as anxiety, and physical sensations. However, in society, they see and hear messages that it’s not okay to stim. That it’s “atypical”, “abnormal” or even “weird” to do. They commonly receive these messages from their school, family, peers, and society. It’s important that they get a different message from you, as their therapist. Whether it’s telehealth or in-person sessions, encourage and support their stimming as a natural and helpful coping mechanism. This, sometimes, will be hard for your clients to do.
If you have a physical office and you’re with a client, you actually might want to have fidgets in your office for clients to use. If you offer group therapy, you can pass a bowl of fidgets around during the session, so that clients can use them to self-regulate and stim if necessary. Even if you’re telehealth, you can model stimming by casually picking up a fidget and using it. This signals to the client that it’s absolutely ok for them to stim in your presence. These are small but powerful ways to accommodate their sensory needs and to normalize stimming.
TIP #5: Encourage Safe Unmasking to Help Your Autistic Clients Meet Their Sensory Needs
Neurodivergent folks often learn to mask their stimming behavior. They’ve been told it’s not “socially appropriate” and that they need to hide it. This can be the origin story of autistic masking, where they suppress their natural, autistic behaviors in order to fit into society’s expectations. This is where the therapeutic relationship plays a really important role. By creating a safe and accepting space for your clients, you can help them feel comfortable enough to be their authentic selves, without any pressure to mask or suppress who they are. Unmasking and feeling accepted is a very healing experience for them.
Autistic people often mask all day long, and often do it unconsciously. They carefully monitor what they say and do, from their facial expressions to spoken words. Constantly worrying if they are “passing” as neurotypical or if they’ll be found out as weird and unworthy. Masking is a protective strategy to help neurodivergent folks fit in and not be rejected. However, masking takes a toll on their body. It is extremely exhausting, emotionally draining, and can trigger sensory overload. There are two key ways that masking can overload an autistic’s sensory system. First, masking places autistic people at higher risk of overstimulation because their nervous system is already pushed to the limit by the physical and cognitive demands of “performing” all day long. Second, autistic people are so used to masking and hiding their true self, that they learn to ignore their own sensory needs. They are more likely to push themselves to the point of sensory overload because they don’t want to stand out as weird or a burden by asking for a sensory break or accommodation.
Supporting Clients in Exploring Unmasking and Reducing Overstimulation
Part of your work with autistic clients is to help them explore how masking may contribute to sensory overload and explore when and how to safely “unmask” to reduce overstimulation. Be aware that the thought of unmasking can be terrifying to clients. Again, they learned to mask to fit into society and reduce the chance of discrimination and interpersonal trauma. So, it is a huge d
ecision to unmask. Unmasking is not an all or none thing. Clients pick and choose when and how to unmask everyday. As a practitioner, it is important to never pressure a client to unmask. Rather, your role is to support them in considering how they can reduce the risk of harm when unmasking, such as intentionally seeking out people and places that are neurodiversity-affirming. The more time they spend in neurodiversity-affirming spaces, the less often they have to mask, which ultimately supports their nervous system, self-regulation, and well-being.
Continue Your Learning with Dr. Tasha Oswald at the Neurodiversity Training Center
If you’re interested in learning more about sensory sensitivities and how to support your neurodivergent clients’ self-care, consider exploring this topic with Dr. Tasha Oswald at the Neurodiversity Training Center. Through blogs, case consultations, and workshops, Dr. Tasha Oswald provides education and resources for therapists, and clinicians who work with neurodivergent individuals. This is only part 1 of a 3-part series on sensory sensitivities. Stay tuned for part 2 where we will dive deeper into the topics of sensory overload and how the responses to sensory overload can stem from trauma. Ready to learn more?
