Megan C. Chang, L. Diane Parham, Erna Imperatore Blanche, Anne Schell, Chih-Ping Chou, Michael Dawson, Florence Clark; Autonomic and Behavioral Responses of Children With Autism to Auditory Stimuli. Am J Occup Ther 2012;66(5):567–576. https://doi.org/10.5014/ajot.2012.004242
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© 2020 American Occupational Therapy Association
OBJECTIVES. We examined whether children with and without autism spectrum disorder (ASD) differ in autonomic activity at rest and in response to auditory stimuli and whether behavioral problems related to sounds in everyday life are associated with autonomic responses to auditory stimuli.
METHOD. We measured skin conductance (SC) at rest and in response to auditory stimuli as well as behavioral responses using the Sensory Processing Measure (SPM) Home Form. Participants were 25 children with ASD and 25 typically developing (TD) children, aged 5–12 yr.
RESULTS. The ASD group had significantly higher resting SC and stronger SC reactivity to tones than the TD group. Correlations between SC and SPM indicated that more severe auditory behavioral difficulties were associated with higher sympathetic activation at rest and stronger sympathetic reactivity to sound.
CONCLUSION. High sympathetic reactivity to sound may underlie the difficult behavioral responses to sound that children with ASD often demonstrate.
Do children with ASD differ from TD children in their SC at rest and their SCRs to auditory stimuli?
For children with ASD, is there a relationship between their SCRs to sound in a lab and their usual behavioral reactions to sounds as reported by parents?
Does your child seem bothered by ordinary household sounds, such as the vacuum cleaner, hair dryer, or toilet flushing?
Respond negatively to loud noises by running away, crying, or holding hands over ears?
Seem disturbed by or intensely interested in sounds not usually noticed by other people?
Seem frightened of sounds that do not usually cause distress in other kids?
Seem easily distracted by background noises such as a lawn mower outside, an air conditioner, a refrigerator, or fluorescent lights?
Show distress at shrill or brassy sounds, such as whistles, party noisemakers, flutes, and trumpets?
This study showed that children with ASD who demonstrate strong behavioral overreactivity to sounds, as measured by an elevated SPM Hearing T score, are likely to have high sympathetic reactivity to sound. Consequently, therapists should consider interventions for these children that address modification of daily routines and environments, as well as self-regulation strategies, to reduce the impact of disturbing auditory stimulation in daily life.
Children with ASD who demonstrate general sensory processing difficulties, as measured by the SPM Total T score, may have elevated sympathetic activation at rest and strong sympathetic reactivity, so for these children, therapists might consider interventions to facilitate development of sensory modulation and self-regulation across multiple sensory systems, to create predictable daily environments and routines, and to plan for anticipated changes in routine or environment.
Children who demonstrate both behavioral under- and overresponsiveness to sounds in everyday life may present strong sympathetic reactivity to sound. Until this phenomenon is better understood, we recommend that practitioners carefully assess the contexts, situations, and types of stimuli involved when sensory questionnaire items indicate that a child both underreacts and overreacts to auditory stimuli to tailor intervention to the needs of the individual child. Individual occupational therapy based on Ayres Sensory Integration® may be particularly appropriate in such cases, with special attention to development of self-regulation of alertness and affect for optimal engagement in occupations.
When educating parents, teachers, and policymakers about the sensory characteristics of children with ASD, this study could be cited as providing evidence that behavior problems related to auditory and other sensory stimuli are associated with physiological events that are not under the child’s voluntary control.
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