Exposure Therapy for Auditory Sensitivity in Autism
Condition: Sensory Disorders; Autism; Autism Spectrum Disorder; Autism With High Cognitive Abilities; Autistic Behavior; Hyperacusis
MeSH terms: Hyperacusis; Sensation Disorders; Autistic Disorder; Autism Spectrum Disorder
Study type: Interventional

Summary: 
      Auditory hyper-reactivity affects up to 66% of children with autism spectrum disorder (ASD)
      and has been linked to greater stress and anxiety for children and their families. Exposure
      and Response Prevention (E/RP) is highly effective for reducing obsessive/compulsive
      behaviors in children with both OCD and ASD. This study is the first to assess the
      feasibility and efficacy of E/RP for auditory sensory hyper-reactivity in ASD.
    

Detailed description: 
      Sensory processing difficulties have been well documented in children with Autism Spectrum
      Disorder (ASD). In fact, "hyper- or hypo-reactivity to sensory input" has recently been added
      to the diagnostic criteria of this disorder. Hyper-reactivity features are particularly
      disruptive to children's abilities to engage in everyday activities and pose a significant
      problem for patients and their families. In children with high functioning pervasive
      developmental disorder, hyper-sensitivity is associated with symptoms of anxiety and
      depression. For sensory processing difficulties, children with ASD are primarily referred to
      Occupational Therapy (OT) services for treatment. These patients are also often seen by
      mental health professionals to address related disorders such as anxiety, ADHD and behavior
      problems. Currently, there are no evidence based approaches for specifically addressing
      auditory hyper-reactivity in ASD. Exposure and response prevention (E/RP), derived from
      systematic desensitization, is highly effective at reducing avoidance behaviors associated
      with phobias and obsessive and compulsive disorder (OCD). In mental healthcare settings, ER/P
      has been shown to be effective for reducing compulsive behaviors in children with OCD and
      concurrent ASD. E/RP has also been piloted for treating restricted, repetitive behaviors in
      ASD and demonstrates good feasibility. E/RP may also be useful for reducing aversive
      responses to auditory stimuli in children with ASD. Occupational Therapists (OT) are the
      primary service for providing treatment for sensory processing and arousal level modulation
      difficulties in children with ASD. Thus, OTs are potentially well suited to provide an E/RP
      aimed at reducing sensory hyper-reactivity in ASD. This study will investigate the
      feasibility and efficacy of utilizing an E/RP approach for treating auditory hyper-reactivity
      in ASD.
    

Intervention name(s): Exposure therapy; Psycho-education; Caregiver education/home program development
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The therapist, child and family collaborate to set short and long term goals, develop the exposure hierarchy and Subjective Units of Distress (SUD) scale and design their "challenge" activities (i.e., exposures). The exposure hierarchy lists activities in ascending order from minimal exposure/minimally difficult (e.g, toilet is not flushed and bathroom door is closed while child walks by) to maximum exposure/maximally difficult (e.g., toilet is flushed repeatedly while child is inside the stall with the door closed). Treatment begins with exposure to activities on the lower end of the hierarchy, with adjustments as indicated, to present stimuli that provide a "just-right" level of difficulty as indicated by the participant's SUD level and therapists clinical judgment. Participants communicate the level of difficulty using their individualized SUD scale. Additionally, the child and family complete home exercises with exposures.; Child and caregiver receive education and training will be provided to improve the participant's self-awareness of his/her behavioral and emotional response to auditory stimuli, his/her ability to self-report anxiety/emotional response levels, as well as his/her ability to identify useful arousal level modulation/coping strategies. During this phase, the child, caregiver and therapist will collaborate to identify the participant's Subjective Units of Distress Scale (SUD) from 0-10 with each level defined, particularly for what levels are tolerable or intolerable.; Parents will be provided with education on home programs to facilitate treatment gains. Home programs will be designed specifically for each participant. Parent education and home programs are provided either concurrently or after the exposure phase for the family to apply these methods to other settings. Home programs can continue as a maintenance program after treatment has ended. At the end of the treatment phase, the study team will conduct the following assessments for a third time: (1) the Sensory Profile, a clinical tool commonly used in OT to assess parent reports of sensory processing difficulties in children, (2) Parent Stress Index - 4 to evaluate stress related to parent-child interactions, and (3) the Modified Khalfa Hyper-acusis Questionnaire to assess the level of hyper-sensitivity to sound.
Other intervention name(s): cognitive behavioral therapy; exposure and response prevention; systematic desensitization
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Single-subjects design (baseline, treatment and follow-up)
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: autism; sensory over-responsiveness; auditory hyper-sensitivity; auditory processing; exposure therapy; exposure and response prevention; cognitive behavior therapy; occupational therapy