Abstract
Objective: The purpose of this study was to evaluate the proof of concept of an intervention to decrease sympathetic activation as measured by skin conductivity (electrodermal activity, EDA) in children with an autism spectrum disorder (ASD) and auditory hypersensitivity (hyperacusis). In addition, researchers examined if the intervention provided protection against the negative effects of decibel level of environmental noises on electrodermal measures between interventions. The feasibility of implementation and outcome measures within natural environments were evaluated.Method: A single-subject multi-treatment design was used with six children, aged 8–16 years, with a form of Autism (i.e., Autism, PDD-NOS). Participants used in-ear (IE) and over-ear (OE) headphones for two randomly sequenced treatment phases. Each child completed four phases: (1) a week of baseline data collection; (2) a week of an intervention; (3) a week of no intervention; and (4) a week of the other intervention. Empatica E4 wristbands collected EDA data. Data was collected on 16–20 occasions per participant, with five measurements per phase.Results: Separated tests for paired study phases suggested that regardless of intervention type, noise attenuating headphones led to a significance difference in both skin conductance levels (SCL) and frequency of non-specific conductance responses (NS-SCRs) between the baseline measurement and subsequent phases. Overall, SCL and NS-SCR frequency significantly decreased between baseline and the first intervention phase. A protective effect of the intervention was tested by collapsing intervention results into three phases. Slope correlation suggested constant SCL and NS-SCR frequency after initial use of the headphones regardless of the increase in environmental noises. A subsequent analysis of the quality of EDA data identified that later phases of data collection were associated with better data quality.Conclusion: Many children with ASD have hypersensitivities to sound resulting in high levels of sympathetic nervous system reactivity, which is associated with problematic behaviors and distress. The findings of this study suggest that the use of noise attenuating headphones for individuals with ASD and hyperacusis may reduce sympathetic activation. Additionally, results suggest that the use of wearable sensors to collect physiological data in natural environments is feasible with established protocols and training procedures.
Highlights
Unusual responses to sensory stimuli are experienced by up to 90% of individuals with autism spectrum disorder (ASD; Ben-Sasson et al, 2009)
It is unclear as to whether sensory processing difficulties are a trait of ASD or a trait of comorbid disorders (Landon et al, 2016), behavioral responses to sensory stimuli have become so prevalent, that the most recent criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) for ASD added a diagnostic component of hyper- and hypo- reactivity to sensory stimuli (American Psychiatric Association, 2013)
Research suggests that the relationship between the central auditory system and the limbic system contribute to the development of the fear and anxiety frequently experienced with hyperacusis (Brout et al, 2018)
Summary
Unusual responses to sensory stimuli are experienced by up to 90% of individuals with autism spectrum disorder (ASD; Ben-Sasson et al, 2009). When studying the neurobiological differences in those with sensory difficulties, research indicates those with sensory over responsivity (SOR), or hypersensitivities, present with atypical sympathetic and parasympathetic functions of the nervous system (Miller et al, 2009). Common in children with ASD, hyperacusis is a term used to describe the negative and/or exaggerated response to environmental stimuli occurring within the auditory pathways (Asha’ari et al, 2010; American Speech-Language-Hearing Association, 2016). In comparison to neurotypical peers, research on multi-sensory integration suggests that children with SOR may not process incoming information in lower level cortical regions. In conjunction with difficulties with sensory gating, challenges with modulation may prevent the central nervous system from appropriately identifying the intensity, frequency, duration, and complexity of environmental stimuli lending to issues filtering meaningful from non-meaningful sounds in the environment
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