This study has been making the rounds. Everything I was hearing about it was horrible and I was appalled right along with the rest of the crowd. How could such a study be published? How could it get past the IRB? They are literally torturing a teenager with sound sensitivities! Of course he’s getting aggressive! I would be too if someone was blasting dangerous levels of sound at me! There was definitely a blog post here. I asked if anyone could get the whole article to me so I could tear it apart properly like the hissy little opossum I am.
Then I read it. I read it a few times. I skimmed through it a few times.
Folks, I don’t think anyone has thoroughly read this study. There are a lot of things to be said about the various reactions to this study. There’s a statement about making informed opinions instead of going along with a crowd, no matter how credible that crowd has been in the past. There are statements about how science is reported in the media, and about making scientific knowledge more accessible to those who may not be experts in the field, but who are affected by it. There’s also a statement about making these articles accessible to those of us who are in the field (lookin’ at you, $40 paywalls…).
Because I believe in accessible information, allow me to break down Assessment and Treatment of Noise Hypersensitivity in a Teenager with Autism Spectrum Disorder: A Case Study, by Fodstad, J. C. et al.
The Participant
The single subject of the intervention was a 16 year-old autistic, referred to as “Aaron.” Although his hearing was tested and fell in the normal range, he demonstrated sensitivity to sound beyond that of neurotypical people his age.
When in the presence of certain sounds, Aaron would engage in dangerous behaviors, including self-injury (hitting his head and chest), as well as aggression towards others, such as hitting, choking, kicking, and throwing objects at others. His biggest triggers included young children screaming and/or crying and these young children were often targeted with this aggression. He also attempted to escape the sounds by covering his ears, screaming or yelling, crying, running away, “freezing,” or stereotypy.
The Procedures
Various assessments were done, including determining that the function of these behaviors was escape from aversive sounds, as well as measuring some of Aaron’s private events, such as heart rate. Through these heart rate monitors, they were able to tell that these sounds were causing Aaron high levels of anxiety. The anxiety levels explained why these escape behaviors were sometimes observed even when the sounds didn’t seem loud enough to cause pain from the neurotypical perspective.
The particular sounds themselves and the combination of the volumes were also pinpointed, as some sounds were also only aversive at certain volumes. Aaron was brought to a safe place and exposed to these sounds at slowly increasing volumes, never exceeding the safe range for normal hearing limits. That is, although the sounds themselves were aversive, there was no risk of damage to Aaron’s hearing.
Perhaps the most important part of the procedure was that the goal was not for Aaron to tolerate these sounds, but to find ways to escape them that weren’t dangerous. He was taught a variety of coping skills and given the choice of which ones he prefered and when. Among these coping skills were singing preferred songs, asking for a break or to leave the area with the use of either words or pictures, looking at preferred pictures, and putting in ear plugs. Stereotypy was not targeted for reduction, but rather used as a cue of building anxiety, at which time Aaron could be prompted to utilize a coping skill before escalating to aggression or self-injury.
The results
At the end of the study, dangerous behaviors significantly reduced. Aaron was independently choosing and using coping skills in the presence of aversive sounds. Physiological signs of anxiety were also measured during the maintenance probes and it showed that none of the aversive sounds produced anxiety anymore. Although he was still escaping the sounds, they no longer made him anxious. These came along with a reduction in outward behaviors associated with anxiety, such as body contortions and increased stimming. Again, not specifically targeted for reduction, but rather indicators of painful private events.
My Discussion
The study was introduced and described as a desensitization study in which an autistic teenager with limited language was exposed to painfully loud sounds until he learned to sit still and deal with it. That is not the case at all. Aside from some ableist language, the authors actually seem fairly aware of feedback from the autistic community and the nature of sensory sensitivity in the autistic experience. The goal here was to move away from desensitization techniques that teach masking and to show that more inclusive methods are just as, if not more, successful in reducing dangerous behavior.
The reports that he was not allowed to use noise-cancelling equipment are simply false.
Noise cancelling tools (ear plugs) were not only readily available, they were specifically taught as an alternative reaction to the sounds. Although the discussion section does suggest that the intervention could lead to eventually fading the use of noise-cancelling headphones for autistic individuals over time, the study itself was not focused on that and did not list it as a goal.
I will agree that fading headphones is unnecessary in most situations, and practitioners who choose to study this intervention further should take into consideration that headphones are just as appropriate a method of escaping aversive sound as ear plugs.
Overall, I found the study actually encouraging for the future of behavioral interventions for people with developmental disabilities. It showed sensitivity to the autistic experience and explored more functional and respectful methods of treating dangerous behaviors. The behaviors targeted definitely needed to be addressed– not only was he in pain, he was engaging in behavior that could result in injury to himself and others, including very young children. The paper gives no evidence that any behaviors were targeted unnecessarily for reduction. Is there room for improvement? Absolutely. But this particular case study seems to have drawn ire unfairly.
I am of course open to corrections if I am missing something here. If any autistics out there have read the entire article and take issue with my interpretation, please do educate me as I am still learning myself.