Sunday, July 29, 2018

Tips to Help Manage Noise Sensitivity in Autism


Tips to Help Manage Noise Sensivity
Unusual sensory responses (i.e., sensory over-responsivity, sensory under-responsivity, and sensory seeking) are relatively common in autism (ASD). While no single type of sensory problem is consistently associated with ASD, one of the most commonly reported challenges for people with autism spectrum conditions is hypersensitivity to noise. Many of the daily sounds that other people take for granted can be very intrusive and painful to children and adults on the spectrum. This article from Friendship Circle lists the types of noise sensitivity and offers some tips on how to help a highly sensitive person cope with everyday noisy situations.
1. Know the types of sensitivity
There are several different types of noise sensitivity, and there are different treatments for each type. Consult with an audiologist to pinpoint which type of sensitivity is affecting your quality of life. These are the 5 most common types of sensitivities, but keep in mind that a person may be affected by more than one issue. For example, my son has hyperacusis in addition to phobias of specific sounds.
  • Hyperacusis is an intolerance of everyday environmental sounds and is often associated with tinnitus, a ringing in the ears.
  • Hypersensitive hearing of specific frequencies is often (but not always) associated with autism. A person is able to tolerate most sounds at normal levels, but certain frequencies are intolerable, especially above 70 decibels. For example, a person may have no difficulty being near a noisy dishwasher, but the higher frequency and higher decibel level of the vacuum cleaner will be painful.
  • Recruitment is directly related to sensorineural hearing loss. It is defined as an atypical growth in the perception of loudness. Hair cells in the inner ear typically “translate” sound waves into nerve signals. Damaged or dead hair cells cannot perceive sound, but at a certain decibel level, surrounding healthy hair cells are “recruited” to transmit, and the person experiences a sudden sharp increase in sound perception that can be shocking and painful.
  • Phonophobia (also called ligyrophobia or sonophobia) is a persistent and unusual fear of sound, either a specific sound such as an alarm or general environmental sounds. People with phonophobia fear the possibility of being exposed to sounds, especially loud sounds, in present and future situations, and sometimes become homebound due to this anxiety.
  • Misophonia is an emotional reaction, most often anger or rage, to specific sounds. The trigger is usually a relatively soft sound related to eating or breathing and may be connected to only one or a few people who are emotionally close to the affected person. For example, my friend Lisa’s son Nate becomes angry and runs out of the dining room because his father makes sounds while chewing food, but Nate does not become angry when his mother and sister make similar sounds.
2. Provide relief
Headphones and earplugs offer instant comfort and relief. Noise-canceling headphones are the most effective, because they replace irritating environmental noise by producing calming white noise. Earplugs are usually made of either foam or wax, and it is worth trying both types to determine which is more comfortable.
However, most audiologists, physicians, therapists and educators recommend against frequent use of headphones and earplugs, because a person can quickly become dependent on them. In the long run, blocking out noise can reduce coping skills and increase social withdrawal.
3. Identify safe environments
One of the first steps that I took for my son was to make a list of his “safe” places and increase his participation there. Depending on an individual’s needs, this could mean:
  • volunteering at the library
  • attending library storytime
  • taking a walk in a nature area every day
  • visiting a park that is near a railroad crossing or helicopter landing pad
  • attending services, prayers or social events at the Shul more often
4. Allow control over some types of noise
At its heart, anxiety is a fear of being unable to control reactions and situations. When my son had a phobia of bells, I gave him several different types of bells to handle and experiment with at home. When we saw bells at customer service desks or in other public places, I allowed him to ring the bell. He gradually became comfortable with the sounds, and he even began identifying speaker systems, alarm systems and other sources of sounds everywhere we went.
5. Allow distractions
When my husband and I took a Lamaze childbirth class many years ago, we learned about the power of distraction in pain management. By giving a person something like an iPad to focus on or an unusual privilege such as bringing along a favorite toy from home, it becomes possible to direct attention away from the offending noise.

[Source: Wang, K. (2014). Noise Control: 11 Tips for Helping your Child with Autism Deal with Noise. Special Needs Resources. Friendship Circle. https://www.friendshipcircle.org/]

Lee A. Wilkinson, PhD is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. Dr. Wilkinson provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorder. He is also a university educator and trainer, and has published widely on the topic of autism spectrum disorders both in the US and internationally. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Wednesday, July 11, 2018

Social Skills Intervention Improves Executive Function (EF) in Autism


             Social Skills Intervention Improves Executive Function (EF) in Autism

Social Skills

Impairment in social communication and interaction is a core feature of autism spectrum disorder (ASD). Social skills deficits include difficulties with initiating interactions, maintaining reciprocity, taking another person’s perspective, and inferring the interests of others. Social relationship skills are critical to successful social, emotional, and cognitive development and to long-term outcomes for students. Research evidence suggests that when appropriately planned and systematically delivered, social skills instruction has the potential to produce positive effects in the social interactions of children with ASD. Both the National Professional Development Center (NAC) and the National Autism Center (NAC) have identified social skills training/instruction as an evidence-based intervention and practice.  
Executive Function

Executive function (EF) is a broad term used to describe the higher-order cognitive processes such as response initiation and selection, working memory, planning and strategy formation, cognitive flexibility, inhibition of response, self-monitoring and self-regulation. EF skills allow us to plan and organize activities, sustain attention, persist to complete a task, and manage our emotions and monitor our thoughts in order to work more efficiently and effectively. Executive function and self-regulation (EF/SR) problems have been demonstrated consistently in school-age children and adolescents on the autism spectrum. Research suggests that operations and activities that require mental flexibility, including shifting of cognitive set and shifting of attention focus are impaired in children and youth with autism. This includes difficulty directing, controlling, inhibiting, maintaining, and generalizing behaviors required for adjustment both in and outside of the classroom without external support and structure from others. EF/SR skills have been linked to many important aspects of child and adolescent functioning, such as academic achievement, self-regulated learning, social-emotional development, physical well-being, and behavioral problems. Research shows that children with strong EF/SR skills are better prepared for school and have more positive social, adaptive, and academic outcomes.

Research

A study published in the open access journal Autism Research and Treatment examined potential changes in executive function performance associated with participation in the Social Competence Intervention (SCI) program, a short-term intervention designed to improve social skills in adolescents with ASD. The Social Competence Intervention-Adolescent (SCI-A) is based on cognitive-behavioral intervention and applied behavior analysis and targets EF, theory of mind (ToM), and emotion recognition as key constructs in addressing social skills impairments.

Behavioral performance measures were used to evaluate potential intervention-related changes in executive function processes (i.e., working memory, inhibitory control, and cognitive flexibility) in a sample of 22 adolescents with ASD both before and after intervention. For comparison purposes, a demographically matched sample of 14 individuals without ASD was assessed at the same time intervals. Intervention-related improvements were observed on the working memory task, with gains evident in spatial working memory and, to a somewhat lesser degree, verbal working memory. The finding of improved working memory performance for the intervention group is consistent with research suggesting that working memory represents an aspect of cognition that may be malleable and responsive to intervention.

Additional research is needed to evaluate to what extent the presently observed gains in EF performance may translate to other age ranges, levels of symptom severity, and other social skills interventions. Further research is also required to examine whether the presence/absence of comorbid ADHD symptomatology may influence the effectiveness of interventions for improving not only social skills but also underlying core EF processes such as cognitive flexibility and working memory.

Implications

Previous research indicates that EF represents an area of weakness for individuals with ASD even after accounting for comorbid conditions such as ADHD. Reviews of the existing literature suggest that cognitive flexibility, working memory, and inhibitory control are often impaired in individuals with ASD. Each of these EF component processes play an important role in the acquisition of knowledge and social skills; the better children are at focusing and refocusing their attention, holding information in mind and manipulating it (i.e., working memory), resisting distraction, and adapting flexibly to change, the more positive the social, adaptive, and academic outcomes. The aforementioned research findings contribute to the growing evidence that children with ASD who participate in social skills interventions that integrate EF skills such as working memory, cognitive flexibility, emotional recognition, and self-regulation experience not only an improvement in social competence, but also underlying core neurocognitive EF processes. Executive dysfunction places a child at-risk and is likely to have an adverse impact on many areas of everyday life and affect adaptability in several domains (personal, social and communication). Systematic social skills instruction that incorporates EF process components in program delivery can help reduce the risk for negative outcomes for children on the autism spectrum. Likewise, an assessment of EF skills can add important information about the child’s strengths and weaknesses and inform intervention/treatment planning. Best practice guidelines for assessment and intervention are available from A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Reference

Social Skills Intervention Participation and Associated Improvements in Executive Function Performance. Shawn E. Christ, Janine P. Stichter, Karen V. O’Connor, Kimberly Bodner,
Amanda J. Moffitt, and Melissa J. Herzog. Autism Research and Treatment
Volume 2017, Article ID 5843851, 13 pages https://doi.org/10.1155/2017/5843851

Lee A. Wilkinson, PhD is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist (CCBT).  Dr. Wilkinson provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorder. He is also a university educator and trainer, and has published widely on the topic of autism spectrum disorders both in the US and internationally. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© 2018 Lee A. Wilkinson, PhD

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