SENSORY AND

BEHAVIORAL ISSUES IN
EARLY AAC USER
M. ARUN KUMAR , M.O.T
Occupational therapist
MERF-ISH
Definition
Augmentative and alternative
communication is any method that
supplements or replaces speech and
writing when these are temporarily or
permanently impaired and inadequate to
meet all or some of a person's
communication needs
NUMBER OF DISABLED POPULATION AND
TYPE OF DISABILITY(SOURCE : CENSUS OF
INDIA 2001.)

Total population -1,028,610,328

Total disabled population -21,906,769
(a)In seeing -10,634,881
(b) In speech - 1,640,868
(c) In hearing -1,261,722
(d) In movement -6,105,477
(e) Mental -2,263,821
 CONGENITAL/DEVELOPMENTAL
DISEASES

Intellectual Impairment (mental retardation)

language (& speech)
 Deaf-blindness – speech & language
Cerebral Palsy – speech ( language)
 Autism Spectrum Disorders – language
Developmental apraxia – speech
Developmental aphasia – language
 Various Genetic Syndromes
 ACQUIRED
DISEASES/DISABILITIES
 Traumatic Brain Injury – speech and/or
language
 Cerebral Vascular Accident – language
(&speech)
 Spinal cord injury – speech
 Laryngectomy/Glossectomy – speech
 Asphyxia – speech and/or language
 Progressive Neurological Diseases
 PROGRESSIVE NEUROLOGICAL
DISEASES
 Alzheimer’s Disease/dementia – speech (&
language)
 Amyotrophic lateral Sclerosis (ALS) –
speech
 Guillain-Barre Syndrome – speech

 Huntington’s Disease – speech (&

language)
 Multiple Sclerosis – speech (& language)

 Muscular Dystrophy – speech

 Parkinson’s Disease – speech (& language)

 AUTISM /ADHD/ LD /CP/MR
AND AAC
SENSORY PROCESSING
 AUDITORY PROCESSING
 VISUAL PROCESSING
 TACTILE PROCESSING
 OLFACTORY PROCESSING
 GUSTATORY PROCESSING
 PROPRIOCEPTION PROCESSING
 VESTIBULAR PROCESSING
 TACTILE DYSFUNCTION
Hypersensitivity to Touch (Tactile
Defensiveness)
 Avoids using hands for AAC activities.
 Avoids group situations for fear of the
unexpected touch.
 HYPOSENSITIVITY TO TOUCH
(UNDER-RESPONSIVE)
 May crave touch, needs to touch
everything and everyone.
 May be self-abusive; pinching, biting, or
banging his own head.
 Mouths objects excessively.
 POOR TACTILE PERCEPTION AND
DISCRIMINATION
Has difficulty using scissors, crayons.
 VESTIBULAR
DYSFUNCTION
Hyposensitivity to movement (Under-
Responsive)
 In constant motion, can’t seem to sit
still.
 Craves fast, spinning, and/or intense

movement experiences.
 Always running, jumping, hopping etc
 Rocks body, shakes leg, or head while
sitting.
 POOR MUSCLE TONE AND/OR
COORDINATION
 Difficulty simultaneously lifting head,
arms, and leg off the floor while lying on
stomach (“superman” position).
 Fatigues easily!
 Poor fine motor skills; difficulty using
“tools”,
such as pencils, silverware, combs,
scissors etc.
 PROPRIOCEPTIVE
DYSFUNCTION
Sensory Seeking Behaviors
 Seeks out jumping, bumping, and crashing
activities.
 Kicks his/her feet on floor or chair while
sitting at desk/table.
 Bits or sucks on fingers and /or frequently
cracks his/her knuckles.
 Love pushing/pulling/dragging objects.
DIFFICULTY WITH “GRADING OF
MOVEMENT”
 Misjudgeshow much to flex and extend
muscles during tasks/activities (i.e.,
putting arms into sleeves or climbing)
AUDITORY DYSFUNCTION (NO DIAGNOSED HEARING
PROBLEM )

Hypersensitivity to Sounds (Auditory

Defensiveness
 Distracted by sounds not normally
noticed by other; i.e., humming of lights
or refrigerators, fans, heaters, or clocks
ticking.
 Runs away, cries, and/or covers with

loud or unexpected sounds

Hyposensitivity to Sounds (Under-
Registers)
 Often does not respond to verbal cues or
to name being called.
 Talks self through a task, often out loud.
 ORAL INPUT
DYSFUNCTION
Hyposensitivity to Oral Input (Under-
Registers)
 May lick, taste, or chew on inedible
objects.
 Frequently chews on hair, shirt, or
fingers.
 Constantly putting objects in mouth
VISUAL INPUT DYSFUNCTION (NO
DIAGNOSED VISUAL
DEFICIT)
Hypersensitivity to Visual Input (Over-
Responsiveness)
 Sensitive to bright lights; will squint, cover
eyes, cry and/or get headaches from the
light.
 Has difficulty keeping eyes focused on
task/activity he/she is working on for an
appropriate amount of time.
 Avoids eye contact.
 Easily distracted by other visual stimuli in the
room; i.e., movement, decorations, toys,
windows, doorways etc.
Hyposensitivity to Visual Input (Under-
Responsive or Difficulty with Tracking,
Discrimination, or Perception)
 Has difficulty telling the difference
between similar printed letters or figures;
i.e., p&q, b&d, + and x, or square and
rectangle.

 Has difficulty locating items among Has

difficulty locating items among other
items; i.e., papers on a desk, clothes in a
drawer, items on a grocery shelf, or toys in
a bin/toy box.
 Often loses place when copying from a
Book or the chalkboard.
 Has difficulty telling the difference
between different colors, shapes, and sizes.
 Makes reversals in words or letters when
copying, or reads words backwards; i.e.,
“was” for “saw” and “no” for “on” after
first grade.
 Difficulty judging spatial relationship in
the environment; i.e., bumps into
objects/people or missteps on curbs and
stairs.
CEREBRAL PALSY AND AAC
VI/HI AND AAC
 BEHAVIOURAL ISSUES
 Aggressiveness- hitting, kicking, throwing
tantrums
 Disruption- screaming, crying
 structure; demonstrate inflexibility when
transitioning between activities
 Self-stimulation (e.g. head banging, biting)
CENTRAL NERVOUS SYSTEM
 ACQUIRED
DISEASES/DISABILITIES
TBI/SI/CVA AT to Consider
 Alertness level
 Orientation
 Cognitive status
 Motor status
 Visual status
 Somato sensory
 Language abilities
 Reading & spelling abilities
 TRAUMATIC BRAIN INJURY
AND ACC
 PARKINSONS DISEASE AND
AAC
PROGRESSIVE NEUROLOGICAL
DISEASES
MD/PD/ALS/AD Behavioral problem s :
Comments and
Questions?