Sunday, March 3, 2013

Inner Vision: Transcending Olfactory Stereotypes in Autism (Part I)

There is little research available on the sense of smell in children with autism. So when I was asked to participate in Play Connection at the Ann Arbor District Library, I said yes. I've worked with high functioning children that have Asperger's Syndrome at 826Michigan Smell and Tell workshops. I have found these children to be some of the most insightful and thoughtful human beings I have ever met. Their evaluation of aroma is creative, playful and precise. When they don't like something they always have a well-reasoned opinion which causes me to reflect on my own preferences.

In accepting the library's invitation I realized I was taking a risk. It wasn't the idea of uncharted territory that gave me pause; it was the research literature I was reading about the sense of smell in children with autism. There seemed to be a pattern of putting autistic children's olfactory sensorial life in a box, which is odd when one considers how little research has been done on odor preferences in children with autism.

The prevailing theory is that children fit into one of two olfactory categories; hypersmellers (extremely sensitive to smells) and hyposmellers (have difficulty smelling). Not much is discussed about the space in between these two extremes in Olga Bogdashina's book, Sensory Perceptual Issues in Autism and Aspberger Syndrome which was published in 2003. A study at the University of Edinburgh in 2010 suggests that reduced vasopressin levels (a hormone that regulates the perception of new and familiar smells) affects social bonding in children with autism. The focus on "dis"-ability leaves out the issue of what lies in the area between the two extremes of over-smelling and under-smelling.

If one took stock in prevailing opinion it would be easy to dismiss olfaction in a play setting with autistic children. The researchers who conducted "Emotional Responses to Odors in Children with High-Functioning Autism: Autonomic Arousal, Facial Behavior and Self-Report"  in 2011 admitted that,  "relatively few studies have dealt with responsiveness to odors in children with autism" on page four of their study. They selected odorants in their study based on "their [the odors'] potency to induce pleasant or unpleasant odor perceptions." This is explained on page five of their study and quoted here for context and edification:

"Eight odors were used in the present study: vanilla (vanillin), cheese (isovaleric acid), rose (essential oil), green grass (cis-3-hexenol), mint (menthol), chlorine, sweat (androstenone), and feces (3-methylindol). The main criterion for selecting these odors was their potency to induce pleasant or unpleasant odor perceptions. Vanilla and rose, widely used fragrances, were expected to be rated as pleasant. In the opposite, feces and cheese were predicted to be judged as unpleasant. Mint and chlorine were selected due to their property to stimulate intranasal trigeminal nerve structures (releasing sensations of freshness or irritation), and not only the main olfactory system believed to be preferentially stimulated by the other odors. Finally, the odors of green grass and sweat were added as representatives of the physical and social environment, respectively. All these odors were presented at suprathreshold concentrations. The odorous solutions and the control stimulus (distilled water) were presented in 60-ml opaque glass jars in volumes of 20 ml."

After reading the paper by Jasna LegiĊĦa, Daniel S. Messinger, Enzo, Kermol and Luc Marlier, I decided to build on their theory of familiar odors and the idea of potency from a literal standpoint. Vanilla is a universally appealing aroma and is familiar as a smell and a flavor. There are several kinds of vanilla used in flavors and fragrances, as well as isolated single molecules that have the dominant characteristics identified with the smell and taste of vanilla.

Madagascar vanilla, vanillin, Tahitian vanilla and heliotropin were chosen as odorants for the Play Connection exercise. Each was compounded in three strengths by Dream Air, which provided a variety of potencies that could be tailored to suit the olfactory needs of an autistic child. In the interest of creating a pattern the children could follow, the bottles were distinguished by a colored sticker, and potencies recorded as small, medium and large. I referred to them as "big smells and little smells" when interacting with the children.

The graphic above illustrates the aromatic properties of the different vanilla aromas that were chosen for the Play Connection program (you can click on the image for better resolution). This was prepared as a handout for parents so they could participate with their children and understand the aromatic properties of the different types of vanilla being used in olfactory play.

Vanilla is an aroma associated with security, comfort, nurture and home. There are several varieties of vanilla used for baking, but the one that is best known is Madagascar vanilla. Madagascar vanilla is sweet, woody and balsamic. Tahitian Vanilla is a more floral vanilla and is typically characterized as sweet, woody, floral, almond-like, and balsamic. Some adults associate the scent of Tahitian vanilla with pipe tobacco because it bears a resemblance to derivatives from tonka beans which are used to flavor tobacco.

Vanillin is the dominant molecule in vanilla and has sweet, milky and creamy nuances. It is also the molecule used to make artificial vanilla (it can be isolated from vanilla beans, wood pulp and other natural sources). Heliotropin is the molecule which gives Tahitian vanilla its distinctive aroma. It is also the odorant that gives Play-Doh® its unique smell. The smell of Play-Doh® is infused with nostalgia, so much so that Demeter Fragrances released a perfume inspired by Play-Doh®. Does familiarity breed pleasant associations? The answer is yes. Heliotropin was piped into MRI machines and shown to have a calming effect on patients at Memorial Sloan Kettering Hospital (63% decrease in anxiety in patients undergoing MRI as part of a study published in 1994).

There was no guarantee that every child who came to Play Connection at the Ann Arbor District Library would want to read the aroma information on the handouts, and/or have the capacity to discuss it (communication is difficult for some children with autism and some of them are non-verbal). As a work around, four hangtags containing an aroma description and a colored sticker allowed children to pick a color versus asking for something by name. This approach added the element of choice and surprise, while taking into account natural shyness and neural issues with verbal communication. Having choices is an integral part of play and puts control into the hands of a child; an approach that takes social anxiety into consideration and creates a sense of safety.

Multisensory context while smelling is important as this is how associations are formed. Adults who are not on the autism spectrum have specific memories associated with vanilla. Children on and off the spectrum who are making olfactory associations may not be conscious of how they relate to smell (it is the most neglected sense in our culture and education, and is an integral part of the experience of detecting flavor). Children ages 8-10 form foundational olfactory memories that stay with them for life. This age group is highly impressionable and finds it easy to talk about good and bad smells.

The equation Smell + Taste = Flavor is an important one to remember. Hypersmellers who have a tendency to smell their food before they eat it already know this. Retronasal olfaction is the name for the convergence of smell and taste that produces flavor. Flavor wheels used to study wine, cheese and other foods help adults form a gustatory vocabulary to describe what they taste and smell. It is a skill that anyone can learn as long as they have a fully functioning chemosensory system.

Describing what we taste and smell is a challenge in all stages in life. This is true because smell is first processed in the limbic system; the part of the brain that manages emotion and memory. It then moves to the cerebral cortex where language is processed. This makes smelling more difficult for children with autism who are easily overwhelmed or aren’t verbal.

Hyposmellers have a hard time perceiving smells and actively seek strong odors. It is possible that they are overcompensating from a survival instinct as the better they smell the more they can tangibly enjoy food as well as sense danger (smoke, spoiled food, etc.). Though this has not been scientifically proven it is a premise worthy of scientific exploration.

Every child responds to smells differently; whether they are on or off the autism spectrum. This is why it is important to respect their feelings and reactions. If they like something, that's fine. If they don’t like something, that's fine too. If the context is comfortable for them it will be easy to tell whether they like something or not.

There is an important issue to contend with regarding olfactory play that no research study has provided answers to; how to deliver aromas so that the sensory preferences of autistic children can be accommodated based on the way they perceive smells. This is a design challenge as well as a delivery challenge. You can't hand a fragrance blotter to a child and expect them to know how to smell it effectively; whether they can smell well or not.

The solution to this issue did not come to me in waking life; it came in a dream inspired by a flower that is famous for its use in perfumery. Stay tuned for Part II of "Inner Vision: Transcending Olfactory Stereotypes in Autism" and find out how the results of this discovery exceeded expectations, and can be applied by teachers and therapists who work with autistic children.
*Part two of this story can be found here.

A big thank you goes out to Laura Raynor, the librarian at the Ann Arbor District Library who invited me to Play Connection so olfaction could be introduced to autistic children as a form of play. Dr. Richard Solomon, the founder of The Play Project, welcomed Laura's suggestion. His favorite vanilla odorant is heliotropin (he was informed of the therapeutic properties after his selection).

Thanks also go out to Dr. Temple Grandin of Colorado State University, and Dr. Leslie Vosshall (of the Vosshall Lab at Rockefeller University). Both women allowed me to interview them as part of the "Inside the Olfactory Mind" series on Glass Petal Smoke. Dr. Grandin taught me to think from the point of view of a person with autism. Dr. Vosshall encouraged me to move forward with my ideas, which gave me the courage to try something that has never been done before. The two of you are some of the most amazing women in research that I know.

DreamAir has been incredibly supportive of all of my olfactory work with children and adults, supplying me with raw materials  and scents for all of the Smell and Tell workshops I've conducted at 826Michigan and the Ann Arbor District Library. Thank you Christophe Laudamiel and Christoph Hornetz for all that you do, and for never saying no when I ask for something.

The Bennetto Lab at the University of Rochester in New York is dedicated to researching the neurocognitive bases of autism. Their current project, "Taste, Smell, and Feeding Behavior in Autism: A Quantitative Traits Study," is funded by the National Institutes of Health (NIH). Click here to find out how to participate in studies at the Bennetto Lab. NIH-funded studies are funded by tax dollars.

Many research papers are not available to the public unless a fee is paid to access them. This type of "embargo" prevents the public from having access to medical studies that could be of interest to them. Glass Petal Smoke hopes that this changes in the future as open source culture has the potential to accelerate progress by increasing public interest, discussion and funding.

"The Case for the Connoisseurship of Smell" provides interesting information of the sense of smell and makes a case for practicing smell calisthenics; whether you have autism or not. This was reinforced in a recent article in the Wall Street Journal titled "Uncork the Nose's Secret Powers".

Image Credits:
The Scent of the Primeval is an illustration by artist Li Pei Huang. It appeared in Chuan Art Magazine, No. 2, "The Sense of Smell". Chuan Art Studio is based in Taiwan. To obtain a copy of this magazine contact [at] gmail [dot] com. Image used with permission of artist. Rights revert back to the Chuan Arts Magazine and Li Pei Huang.

Image of Geomant 60: Polysensorial Metaphoric Dimension is from the Strategic Challenge of Polysensorial Knowledge and is licensed under Creative Commons.

All other images designed by Michelle Krell Kydd.