A Multi-Disciplinary Exposure Therapy Approach to Treating Auditory Sensory over-Responsiveness

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: The present study is a clinical pilot to determine 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 at the University of Florida Center for Translational Science Clinical Research Center to patients (n = 5) with high functioning ASD ages 5-17 with strong aversions to specific sounds. In addition to autism diagnostic assessments, participants also completed cognitive testing and caregivers provided reports for adaptive behavior scales and sensory processing. Exposure therapy was provided to each participant for up to 12 weeks. Prior to beginning exposures, patients and caregivers were provided psychoeducation on how to identify levels of anxiety and arousal level as well as how to enact self-regulation strategies. Exposure hierarchies were designed to address specific auditory aversions. Parent and patient reports were collected weekly before, during and after treatment regarding the participants’ behavioral responses and levels of anxiety experienced when exposed to these sounds. Participant performance on self-reported distress scales, caregiver reports and behavioral observations are compared within subjects across three phases: baseline (no treatment;4 weeks), treatment (12 weeks) and follow-up (home programs; 4 weeks).

Results: Preliminary results suggest good feasibility and that patients with high functioning ASD respond 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 can be useful for 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 such patients. Further studies are warranted to further evaluate treatment efficacy, generalization/maintenance of treatment outcomes, patient-treatment matching as well as follow through with home programs. The results from these studies can serve to: (a) improve children’s abilities to tolerate every day sounds and to engage in activities of daily living and (b) improve evidence-based approaches to 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.