Treatment for Auditory Hyper-Reactivity Behavior in Children with Autism Using Exposure and Response Prevention Principles

Background:  Auditory hyper-reactivity is estimated to affect up to 66% of children with autism spectrum disorders (ASD) and has been linked to both child and family mental health factors such as higher levels of stress and anxiety. Although hyper-reactivity to auditory stimuli is a significant problem for these children and their families, there are currently no evidence based treatments available to treat this problem in ASD. Exposure and response prevention (E/RP) is highly effective form of treatment for reducing escape/avoidance behaviors associated with obsessive and compulsive disorders, anxiety and phobias. It has also been shown to be effective for reducing OCD behaviors in children with concurrent ASD suggesting that children with ASD may also respond well to this type of treatment approach being applied to sensory hyper-reactivity behaviors.

Objectives: Case series reporting the feasibility of implementing a modified E/RP approach for reducing auditory sensory over-responsive behaviors in children with ASD.

Methods:  A modified E/RP protocol was provided in an outpatient therapy clinic to patients with high functioning ASD who report a strong aversion to specific sounds. Parent and patient report information was collected pre- and post- treatment regarding the level of difficulty tolerating certain sounds as well as a description of types of behavioral responses and level of anxiety experienced when exposed to these sounds. Behavioral responses and self-reported levels of anxiety were collected each treatment session before, during and after exposures. Exposure hierarchies were designed to address specific auditory aversions for each patient. Prior to beginning exposures, patients and parents were educated on how to identify and report levels of anxiety and arousal level through self-regulation treatment strategies such as Zones of Regulation or the ALERT Program.

Results:  Preliminary results suggest that patients with high functioning ASD respond well to a modified E/RP protocol as evidenced by decreased avoidance/escape behaviors and decreased self-reported levels of discomfort/anxiety to auditory stimuli that were initially reported to be intolerable.

Conclusions: A modified E/RP approach is feasible to implement for the purpose of reducing avoidance behaviors and anxiety associated with auditory hyper-reactivity in patients with high functioning ASD. This study supports the idea that auditory hyper-reactivity, in some patients, may be the result of a conditioned response and thus, an E/RP based approach may be effective for these patients. Further studies are warranted to further evaluate the efficacy of this approach, generalization and maintenance of treatment outcomes, patient-treatment matching as well as parent education/training on home programs. The results from these studies can potentially: (a) improve children’s abilities to tolerate every day sounds and to engage in activities of daily living and (b) improve evidence-based practice for treating sensory processing difficulties in ASD. This work represents the first step in evaluating the feasibility and efficacy of applying E/RP treatment to reduce auditory hyper-reactivity in children with ASD.