Based on the CONNECT with SUCCESS Autism Podcast Episode 3
With Dr. Lynette Scotese-Wojtila and Dr. Richard Smith
“Sense-making” is simple concept, but we don't always talk about it, because for most people, it just happens. Keep reading to learn how sense-making happens for individuals with autism.
What is sense-making?
Sense-making is the process through which we learn, or we come to understand or comprehend something. It's how we arrive at an understanding of people or things, events, experiences, and how we make sense of what's going on around us, and what's going on within us.
When a child is born, they don't come out of the womb already knowing and having a lot of sense about their world. They slowly evolve to understanding through their experiences.
For example, when we were young, we felt a sensation of thirst, a very normal experience. We have all felt thirst this, and sometimes it doesn't always register. It's sort of in the background, but as the day goes on, the longer it is between times when we drink and quench ourselves, our feelings of being thirsty rises up, and all of a sudden it moves from this little something to something that grabs your attention, so you focus on it.
And even though there are many sensations coming into our bodies all day long, this particular sensation – thirst – bubbled up above all the others, and grabbed our focus and our attention. For those of us who are old enough to have language, we know the feeling of thirst and we have learned to put a name to it: “I am thirsty. I need a drink”
And so once we were aware of it, we label it and we do something about. We can take action about the thirst. We find a water bottle or a drinking fountain. We quench our thirst. This is sense making.
Do children with autism have trouble with “sense-making”?
For children with autism, sense-making does not come this easy because it's not always so natural.
Remember that sense-making relies on experience and a brain that can process that experience; and it also relies on sensation. Our senses inform the brain and help the brain to become aware of something, something becoming figural, that we can then attach meaning to and make contact with. And so this reliance on awareness and sensation is critical.
Most everyone processes through this cycle and the circle of awareness because the brain and body are designed to work together so that experiences are meaningful and we can thrive and sustain. But sometimes there are blockades in the cycle. And, you know somebody maybe doesn't have good language and so we might be attaching the concept of thirst or bottle or drink to a child, let's say a toddler, and if they're not grasping the concept that are the words that we're labeling, they may not have a lot of sense-making around that sensation of thirst because they miss the tie to the language. So when mommy says do you want a drink? Are you thirsty? If the child is not processing that word, they might have the sensation of thirst, they may have that bodily sensation, but it's not tied or associated or connected.
So do people with autism make sense of things that the way others do? Is it the same for everyone in that process, in terms of having autism?
It is the same process for everyone. Those six or seven steps that we go through from the sensation to something becoming figural, or in focus, and that becoming aware of it, and taking action to get in contact with it, those steps are very natural and normal for everybody that can process well; but for kids with autism and other sensory processing problems, they get stuck, and they get stuck at various places in a circular process. Sense-Making is a Circular Process
So when we talk about processing information, or sensation, we have to recognize that it is a normal and natural process. Our brain will inform us -- these senses will inform us -- that something's going on we have to pay attention to, and as we become aware of it, we sort of go through this circular process, and it's actually in the field of Gestalt psychotherapy.
There is a circular process of awareness, and what happens in this circular process is:
· we take in lots of information and sensations
· one particular sensation kind of grabs us
· and we become aware of it
· and we put a name to it
· we move from being aware of it, to wrapping our brain around it, and getting in contact with it.
· And when we come into contact with something, we have sense-making about it.
If we said to a young toddler, “You're thirsty.” A toddler who is tumbling around at 13, 14, 15 months probably doesn't understand what “thirst” is because it's kind of an abstract concept. Thirst is a sensation, but they might associate a bottle or a typical sippy cup with the concept of thirsty. So this is how we learn. This is how we have sense-making through experiences, through sensation, through becoming aware of those sensations and those turning to put labels to them, and fix or make contact with whatever it is that we are having sense-making about.
Sense-Making is a Natural Process
Sense-making is a normal, beautiful, spontaneous, organic process, where it's very subconscious. It's not robotic. It's not heady. It's sort of natural and almost subconscious, but experience is accumulating in our brains all the time. And that's how associations are built through experience.
So what does sense-making rely on, specifically?
It relies on experience and a brain that can process that experience; and it relies on sensation. We talked about the senses informing the brain and helping the brain to become aware of something, something becoming figural that they can then attach meaning to and make contact with. And so this reliance on awareness and sensation is critical. And it is not to be taken for granted because it's natural for many people, but it's not always so natural and kids with disabilities.
Does everyone process through this cycle and the circle of awareness?
They should. The brain and body are designed to work together so that experiences are meaningful and we can thrive and sustain. We all go through the cycle, but sometimes there are blockades in the cycle. If a person does not have good language, for example a toddler, and they're not grasping the concept of the words that we're using to label, they may not have a lot of sense making around that sensation of thirst because they miss the tie to the language. So when mommy says do you want a drink? Are you thirsty? Or do you want juice? If they're not processing that word, they might have the sensation of thirst, they may have that bodily sensation, but it's not tied or associated or connected.
An Example of Getting Stuck in the Circular Process
In the movie Rain Man, there is a scene where Dustin Hoffman, who plays Raymond Babbitt, visits Las Vegas with his brother, Charlie Babbitt (played by Tom Cruz), who gets him a “date” for the evening. And he's with this date in a bar with him, and she's dressed to the nines. And she has on, as part of her apparel, this chain, this necklace. And in the movie Raymond is noticing, very much so, that necklace. And the person watching the movie, is just kind of seeing him look at it and he's there with this beautiful woman, and they're kind of picking up that the woman's a little turned off because all Raymond is doing is staring at her “shiny” jewelry, and isn't making eye contact, and he starts to say weird things. And it's comical when you see how they very artfully relate this kind of issue in the movie in Hollywood, but in reality it isn't funny at all. Raymond was stuck on this cycle of experience. He was stuck on the necklace, which is a sensory factor. The intention of him going on a date with the beautiful woman was a human relationship, a human conversation, but his attention was on the necklace. And we know this, not only because we can watch his eyes and see him looking only at that shiny object, rather than her; but when he goes back upstairs to his brother Charlie Babbitt, Charley says, “How was your date?” And he says, “Shiny, very shiny.” And so, you can tell that what he processed -- his takeaway from this fixed date -- wasn't a relationship. He took away the image or the sensory experience, the sensory association for her necklace, which means he probably didn't look at her face, didn't look into her eyes and didn't really engage with her. This shows how individuals with autism process sense-making in a much different way than how we do. We would look at the person. We would acknowledge their presence. We might even have a conversation, depending on the relationship. It is a really important difference. We have to acknowledge that individuals with autism may be stuck on this circular process -- the cycle of awareness -- or this sense making cycle, and so they need help, they need help to work through where they are stuck.
How can you help someone who is stuck in this circular process?
In episode two about observing readiness, Dr. Smith and Dr. Scotese-Wojtila discussed a time when Dr. Smith took his young daughter to a birthday party at an arcade. When it was time for the party to begin, his daughter became distracted by the flashing lights and sounds, and it triggered something in her that showed Dr. Smith that she wasn't ready to be social in that particular setting. They actually had to remove her from the party.
Here is how Dr. Smith could have prepared his daughter prior to attending the party: Because the object of the event was socializing, Mom and Dad need to be able to get their daughter through everything that she will be exposed to – lights, sounds, people. The goal is to “make contact” with the child who is hosting the birthday party.
And if a child can't get past the sensory load, they are not going to see people. She will stop at lights and sound. So, in that instance, Dr. Smith’s daughter was stuck in sensation, and there's nothing Dr. Smith could have done at the moment to talk her through it, because additional talking would have just been another stimulus, another source of sound.
Dr. Smith says they had to pull her back into the car -- away from the lights and sounds -- and talk about what she might see and what she might experience to try and help her through it.
In a situation like this, think of the “rewind” button. Bring her back to the car to validate her experience. Bring her back -- like a do over – and help her to focus on the friend. So one strategy would be is to say to her:
“You are going hear some things that might be loud, and you're going to see some things that might be bright. But what we're going to look for is Mary. Mary is the name of the friend we are looking for, right? We're going to use our eyes to find Mary. I will help you. I can help point to her, I can take your hand and bring you to her, I can wave to Mary to come to you, but we're going to think about Mary. And when we meet Mary, when we're close enough that she can hear us, we're going to tell her 'Happy Birthday' and give her a gift.”
In this example, the parent is giving the child a directive, and the parent then supports them to actually enact that joining to, in this case, this person named Mary. Then they have a focused intent, and the child has already been warned about the sights and sounds.
If that child can be talked through it, cognitively, then that is a great outcome. If she can, then she has what we call cognitive override that can sort of tell her, “Okay, Dad said, ‘Think about Mary. Think about Mary.’”
It doesn't mean she's not hearing the sounds and not seeing the sights, she is, but the parent has given her something, a focal point. The parent is setting her up to succeed.
What Not to Do
It is important to realize that children with autism get stuck often, and they get stuck in ways that we don't. So, if we're not careful, we may become angry and frustrated and respond with, “Just go give her the gift!” Or a teacher might say, “Just finish your math. Come on, you've got three more, you know this, you know!” But if there's a distracting sound near the child who is trying to finish their math, and that resonating sound is still bothering their ears, they are not going to be able to make contact with their pencil, and the concept of computation for their math problem. They are stuck in sensation because of the auditory memory pulsing through their ears. Join Them Where They Are At
The teacher is able to move past the distracting sounds, but the child is not. So we have to understand that these kids get stuck because it explains their behavior. And once we understand where they're at in the cycle, we have to join them. We have to join them where they're at. Stay with them as long as they need us to, and then help them through it.
So in that instance, it might be telling your third grader trying to finish three math problems:
“I know you're hearing the noise, it's loud. Take one minute, put your hands over your ears and press as hard as you can. And while you're pressing, the sound might be less, and if it is, you can finish your math. If it isn't, you can do it tomorrow. I understand.”
So just giving them that validation:
“You're still hearing the sound. We don't hear it, but you hear it. Let us help you get rid of the sound. And if nothing else, if I can't help you get rid of it, I'm going to take the demand away from you to perform while you're having it.”
Join Them by Pointing, Labelling, Showing
Another way to help children with sense-making is to label, point and show them. In our class called An Introduction to The S.U.C.C.E.S.S. Approach (SM) for Parents and Caregivers, there is a research study that we talked about, and it was done by Sylar and Sigmon in 2002. And the study found that caregivers of children with autism who tried to maintain their child's spontaneous contact with toys by pointing or showing or commenting had children, who later developed superior communication skills, measured at one year 10 years, and 16 years. So just by helping that child stay in contact by pointing to the toy, labeling it, showing, commenting, all those “joining” things that we do with kids. Those children ended up having superior language, over the course of 1, 10 and 16 years which is really phenomenal. When you think about it. And that's compared to children who maybe had more demands placed on them, or more directive kind of intervention. When it was undemanding language, and they were focused on staying in contact, versus performing, those children have superior communication skills.
Here's the challenge though. It's not easy to operate this way. It's not easy to operate from the perspective of joining somebody else, as they're on the journey to sense-making. And so, in order to get good at that, we have to sort of disconnect from our self for a minute, and really look and assess where the child is in the process. And the challenge, when we're talking about a child with autism, discerning that is it's so different from where we are. Again, the example of Rain Man with a woman with him, didn't have a clue that he was looking at her necklace. It was me. At the bar with him, and I had a necklace on. And he looked at it, I would join him rich. I would say, "Raymond. You see, my necklace." I might even say, holding it kind of juggling it. "It is, as you might say, shiny." And I'd say, "I have shiny eyes too." And what do you think he might do?
He would most likely look at my eyes, which could lead to engaging socially, which was the original goal of getting together.
Another Tip: Give an Expectation to DO SOMETHING not “Stop” a Behavior
Most of the time, parents give commands to stop. Stop running. Stop jumping. Stop talking. We would rather it be an expectation to do something. A lot of our kids with autism and a lot of our girls with autism are constantly told STOP. One way or another, they're told to stop. They're inhibited, they're prevented. They're held back. Don't do that. Whatever it is, Don't run, don't touch this, don't eat that, don't ask for that, don't scream. Don't -- whatever it is -- don't, don't, don't, don't, don't! But by joining them where they are stuck, in the Rainman example, where we wanted Raymond to look at the woman and interact with her, she could have said, “My eyes are shiny too.”
Not telling him to look at me. Not telling him to stop looking at the necklace. Joining him in his awareness of the shiny necklace, and giving him the opportunity to comment on it, and what we know about people with autism is they really want to talk about what they're thinking about. We know that.
And so by joining them and saying, “Yes it is shiny, it's silver, or it's 14 karat gold, isn't that interesting?” opens up a whole conversation.
And my tactic initially was my eyes are also shining, and then when he looks, you know, he might say yes they are. I would say they're shiny and they're brown, and yours are whatever, and I comment then, then we're commenting on the here and now. And that's very very central, it's a centerpiece of Gestalt theory, being in the here and now, very present centered, and sensemaking. Those are the three factors that really identify Gestalt theory. And if we understand this, we can make use of this awareness process, the sense making process, and stay present centered until the child understands what we're presenting. It's exciting work.
Sense-making and teachable moments
Parents instinctively use the word "stop" because they are feeling protective and want to make sure that their child is not going to do something that's going to hurt them. But the whole idea of sense making is a teachable moment, to bring them into focus.
And if we want them to learn something new to keep them safe, try telling them what to do. It sounds more like, try walk. I will help you. Let's walk together. That's right, we have walking feet. Let's walk to brother's room. Let's walk to the parking lot.
Whatever you're doing, you join them. And what you want them to do, and model in the process what you want them to do and guess what they do? What you want them to do. If you don't tell them what else to do, then what their first inclination is, is going to win.
So we always say The S.U.C.C.E.S.S. Approach wins when we reshape something to the outcome that we want, that's better for the child, the greater good of the child, like not running in the parking lot, but autism wins when we do it wrong. And they take off running because we said things like “stop” versus what to do -- like “try walking” -- they can't process, if they could stop, they would stop.
Yelling “stop” doesn't necessarily become effective for some kids for many kids, if they don't know what else to do.
Weekly Challenge: Look for signs of where your loved one might be getting stuck in their cycle of awareness. Look for them getting stuck in sensation. Look for them, maybe getting stuck in action, where they can't stop something once they start, and try to join them so that they can complete the cycle, and actually achieve sense-making. Turn to your occupational therapist to help you with this. They can help you identify where they're at, how to move them, and how to achieve sense-making.
This blog post is based on the Connect with Success Autism Podcast, Episode 3, April 14, 2021, With Dr. Rich Smith and Dr. Lynette Scotese-Wojtila
The mission of Connect with Success autism podcast is to lead you to a new and exciting way of understanding, responding to and helping all those with autism. We hope to expand your thinking about how to best serve these amazing people and how to support you in your daily struggles and celebrations. Based on The SUCCESS Approach.
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