Exposure Therapy for Auditory Sensitivity in Autism

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.

Inclusion Criteria of children:

- autism spectrum disorders (ASD) diagnosis with symptoms of auditory
hyper-sensitivity/reactivity.

- verbal communication skills for utilizing the Subjective Units of Distress (SUD) scale
(no cut-off for IQ).

Exclusion Criteria of children

- behavioral diagnosis of Oppositional Defiant Disorder or Conduct Disorder

- history of child abuse that is related to sound sensitivity