Wednesday, November 1, 2017

Sensory Hypersensitivity in Autistic Adults

Sensory Hypersensitivity in Autistic Adults

Anecdotal reports and empirical evidence suggest that atypical or unusual sensory responses are a common feature of autism spectrum disorder (ASD). Studies report that from 45 to more than 90 percent of people with autism either ignore or overreact to ordinary sights, sounds, smells or other sensations. Sensory issues are now included in the DSM-5 symptom criteria for restricted, repetitive patterns of behavior, interests, or activities (RRB). This includes hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment; such as apparent indifference to pain/heat/cold and adverse response to specific sounds or textures.  Although no one single type of sensory problem is consistently associated with ASD, auditory sensitivity is often cited as the most disturbing and challenging for autistic individuals.
We live in an incessant cacophony of noise. In fact, scientists say it’s the noisiest age in human history. We know that “noise pollution” can cause hypertension, high stress levels, tinnitus, hearing loss, sleep disturbances, and other harmful effects. Sound becomes unwanted when it either interferes with normal activities such as sleeping, conversation, or disrupts or diminishes one's quality of life. Certain sounds are particularly annoying collectively to us all. However, many of the everyday noises other people take for granted can be very painful and cause unwanted intrusions for autistic adults. For example, many autistic adults report sound sensitivity problems such as hyperacusis, misophonia, hypersensitive hearing at certain frequencies, and phobias (phonophobia) related to specific sounds. When present, sensory problems can interfere with adaptability in many areas of life (communication, daily living, socialization, occupational). Understanding sensory issues in adults on the autism spectrum is critical to the identification and prescription of appropriate interventions especially considering studies that suggest a link between anxiety and sensory over-responsivity which can further compromise an individual's ability to function successfully in daily life.

A study published in
Autism investigated sensory over-responsivity in adults compared to control participants and the extent to which daily life experiences were endorsed as uncomfortable or distressing by those on the spectrum. The researcher’s hypothesized that adults with autism would report more sensory over-responsivity than controls. A second objective was to test whether sensory over-responsivity is linked to autistic traits in adults with and without autism.
Adults with (n = 221) and without (n = 181) autism spectrum conditions participated in an online survey. The Autism Spectrum Quotient (AQ), the Raven Progressive Matrices and the Sensory Processing Scale were used to characterize the sample. Adults with autism spectrum conditions reported more sensory over-responsivity than control participants across all sensory modalities (vision, hearing, touch, smell, taste and proprioceptive). However, the highest mean scores were reported for Hearing and Touch on the Sensory Processing Scale.
These findings highlight the importance of measuring each sensory domain separately rather than combining scores from various sensory domains. Notable in this study was the association between sensory over-responsivity and autistic traits. Increased sensory sensitivity was associated with more self-reported autistic traits, both across and within groups. These results indicate that autistic adults experience sensory over-responsivity to daily sensory stimuli to a high degree and that a positive relationship exists between sensory over-responsivity and autistic traits.

Despite its limitations, this study shows that autistic adults self-report over-responsivity across multiple sensory domains (vision, hearing, touch, smell, taste and proprioceptive) that affect their daily life routines and thus quality of life. Auditory over-responsiveness was among the most frequently reported by participants indicating that autistic adults experience challenges to daily auditory stimuli to a high degree. Although sensory symptoms may improve with maturation for typical individuals, sensory features in ASD remain stable and often become more challenging during adulthood. Likewise, sensory over-responsivity has also been linked to higher rates of depression and anxiety. 

Although there is no cure for sensory sensitivity, there are various techniques as well as some lifestyle modifications that can tone down the symptoms of auditory sensitivity, so it does not severely interfere with everyday life. They include exposure and response prevention (E/RP) treatment; habituation training, applied relaxation, positive imagery, attention shifting, psychoeducation, cognitive restructuring, and background sounds to cope with hyperacusis. The most effective solutions involve increasing the tolerance of noise by exposing the person to sufficient noise to build up his or her “immunity.” Over-protection may only further increase the effect of extreme sensitivity to sound. Evaluating and attending to over-responsivity have implications for understanding and addressing the sensory components of autistic adults' daily life routines and roles. Appropriate intervention should be directed towards sensory issues that may be contributing to emotional and psychological challenges and towards designing sensory friendly domestic and work environments.
Tavassoli T., Miller, L. J., Schoen, S. A., Nielsen, D. M., & Baron-Cohen, S. (2014). Sensory over-responsivity in adults with autism spectrum conditions. Autism, 18, 428–432.  
doi: 10.1177/1362361313477246

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. 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 and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also the editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in SchoolsHis latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd edition).

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