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64 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 2 examples of stimming, which helps defuse the building anxiety they may be feeling. Depending on the degree of discomfort, the associations the individual has made with the stimulus, and their own coping mechanisms, their reactions may range from displeasure to extreme anxiety or panic. This should not be treated as an overreaction; if they can't stand the texture of the sheet on your treatment table, find another fabric. If the lights are too bright, dim them or switch them off. The autistic patient may feel too shy to ask this, but if you notice visible discomfort, or an increase in stimming, ask them if there is anything in the room making them feel uncomfortable and give them a cue by asking directly about the lighting or fabrics. They may even refuse to sit down if they don't like the texture of a chair—always meet them at their comfort level. Check whether oils or creams used (and their scents) are tolerable. This characteristic will also impact how autistic people respond to touch: Begin by discussing it, explain what your treatment involves, talk them through any assessment procedures clearly, and ask them whether they have questions before proceeding. Check if there are any parts of their body (apart from the obvious) where they do not like to be touched (feet and legs for example), and if dealing with a particularly sensitive individual, ask them to demonstrate (on their own arm or on yours) what degree of touch they find tolerable and/or disturbing (they may be fine with firm pressure but disturbed by light stroking, for example). The neck and throat area are often particularly triggering—ask them before touching. Be flexible and be prepared that the same individual may respond differently on different days depending on their anxiety levels. They are not being "difficult"; there will be a context they may not be able to explain depending on the day or week they've had. Emotional Regulation As noted earlier, this can be expressed in the form of strong or underwhelmed reactions to situations and stimuli. You may encounter autistic individuals who express way that fits in with their existing comfort zone. Ask the client what aspect they find discomfiting, and help frame the change in a way that might work for them. Do not try to "educate" or use arguments such as "but it's good for you" or "but you're harming yourself by eating this way." There may be sensory, psychological, and other issues you cannot tackle outside a multidisciplinary context, and "lecturing" an autistic patient will send them into an anxiety spiral and break trust. Work with them to discover their tolerance levels for additions or changes to a routine, and don't underestimate their intelligence. They speak a different language; it is up to you to find the balance that will work. Altered Sensory Sensitivity Unusual responses to sensory stimuli among autistic individuals are well-documented, whereby the texture of a fabric may be so disturbing they cannot even look at it, or certain sounds, scents, or food textures may be equally upsetting. This is one reason why autistic people sometimes make repetitive gestures such as flapping their hands, playing with a piece of clothing or strand of hair, or picking at their fingers; these are all