Earplugs And Sensory Reduction In ADHD and Autism

According to findings from the CDC, an estimated 2.21 percent of adults aged 18 or older in the United States have been diagnosed with autism spectrum disorder (ASD) as of 2017. But for children, that number is even higher. Some 23 out of every 1,000 children have to cope with the social, emotional and sensory stress of living with ASD each day of their lives.

Yet those numbers are minor compared to attention deficit/hyperactivity disorder (ADHD.) With approximately 4.4 percent of the adult population and of 9.4 percent of children in the US having been diagnosed with ADHD, it remains one of the most rapidly growing non-fatal medical conditions in recent years, totalling a 1 percent annual increase between 2008 and 2011.

But individuals without either condition often fail to realize how everyday occurrences in our environment can place an overwhelming amount of stress on a child or adult with ASD or ADHD. Everyday occurrences which many of us take for granted. Even the most ordinary sounds (such as the honking of a car or the chirping of a bird) can be enough to trigger a sensory meltdown.

Yet neither ASD nor ADHD are synonymous with one another. Not only are they entirely separate conditions with entirely different symptoms requiring entirely different forms of treatment, what triggers their behavior can be entirely different as well. Yet there’s some forms of sensory reduction tools they can share in common—earplugs being just one of them.

We’ve touched briefly on this topic elsewhere on this blog before, and new developments in sensory reduction tools remains a common question we’re asked about. But before we discuss how particular breakthroughs in sensory reduction can make a positive impact in ADHD and autism, let’s review what exactly those terms mean.

What is Autism Spectrum Disorder (ASD)?

Autism spectrum disorder (ASD) is a developmental and behavioral disorder marked in many cases by difficulty in communicating and consistently interacting with others (in some cases, almost entirely) and restricted, often repetitive behaviors. While many individuals who have been diagnosed with ASD have learned to function socially quite successfully, others have symptoms which impede their ability to learn, interact and communicate with others and their surroundings.

Yet ASD is known as a spectrum disorder owing to the diversity in which it can present itself. In some cases, social adjustment can be a minor challenge—but not an insurmountable one. In others, communication and socialization can be severely limited and require constant supervision. While ASD can occur in either gender and isn’t necessarily a hereditary disorder, it is more notable among males and can sometimes be diagnosed as early as 2 years old.

Common sensory triggers and sensitivities in individuals with ASD can include:

Sights

Sounds

Smells

Tastes

Touch

Balance

Awareness of body position and movement

Awareness of internal body cues and sensations

All of which may be classified as being either hypersensitive (over-responsive), hyposensitive (under-responsive) or a combination of both.

What is Attention Deficit/Hyperactivity Disorder (ADHD)?

Attention deficit/hyperactivity disorder (ADHD) is in many ways the opposite of autism. It’s a neurodevelopmental disorder marked in many cases by an inability to control impulses and behavior, over-activity or an inability to pay attention. In many cases, an individual diagnosed with ADHD can fall under three categories:

Predominantly inattentive presentation: In which an individual may have difficulty paying attention to details, following instructions or finishing tasks.

Predominantly hyperactive-impulsive presentation: In which an individual may have varying degrees of difficulty controlling impulsive behavior, sitting still for long or exhibit otherwise extreme degrees of restlessness.

Combined presentation: In which any of the above traits are present.

ADHD is most typically diagnosed in childhood, although associated traits frequently last well into adulthood. Common sensory triggers and sensitivities in individuals with ADHD can include:

Background sounds

Bright lights

Chewing

Clothing and food textures

Fragrances

Movements

Stress

All of which can trigger extreme irritability, discomfort, stress, anxiety and withdrawal.

Treatment for ASD and ADHD

Because both ASD and ADHD are behavioral conditions which can emerge in distinct ways, there’s no standardized form of treatment available for either. However, there are therapeutic models available for both conditions which are becoming more commonplace.

Applied behavior analysis (ABA) is a widely accepted form of therapy primarily used for children with ASD. ABA involves recognizing behavior based on understanding the “why” of an ASD child’s behavior while also striving to improve critical communication and motivational skills early on in their development.

Medication treatments are primarily used in the treatment of ADHD, though not without controversy due to their prevalence for non-prescribed abuse. For children diagnosed with ADHD, medications approved by the FDA can be either stimulants or non-stimulants. While there is no generalized form of medication treatment available for ASD, the FDA has approved the use of mild antipsychotics for the use of extreme irritability for some children between the ages of 5 and 16. As with any form of medication, always consult with a physician before requesting any prescription treatment for a child.

Cognitive behavioral therapy (CBT) is a form of psychotherapy focusing on the interplay between emotions, thoughts and behavior, particularly concerning personal strengths and weaknesses. As a goal-oriented form of therapy, CBT is widely applicable in addressing numerous disorders and interpersonal relationships; but more recently, it’s been successfully adopted by many behavioral and developmental specialists as a method of resolving many of the common issues faced by individuals with ASD and ADHD.

Sensory Reduction in ASD and ADHD

One particular area in which ASD and ADHD can sometimes overlap is in sensory processing dysfunction, where both hypersensitivity (over-responsive) and hyposensitivity (under-responsive) reactions to tactile, visual and auditory stimuli are pronounced. Technically, sensory processing dysfunction has not been found to be a separate disorder, but a symptom which can be characteristic of both conditions.

Hypersensitivity tends to be more frequent in ADHD, with recent studies indicating that some 46 to 69 percent of diagnosed male children experience some form of over-responsiveness to stimuli; while sensitivity to auditory stimuli, in particular, can occur in as high as 16 percent of school-aged children. The technical term for hypersensitivity to external sounds is hyperacusis; and while it’s worth noting that individuals diagnosed with the condition may not necessarily exhibit traits common to both ASD and ADHD, it’s been estimated that it occurs in some 63 percent of ASD cases.

Breakthroughs in Hyperacusis Therapy

One of the reasons why it’s difficult to gauge the exact percentage of the general population who may experience hyperacusis is the fact that it has been linked to more common auditory conditions, including tinnitus and Ménière's disease, as well as non-auditory specific conditions—not the least of which includes ASD and ADHD. A recent survey was published in BMJ Open proposing a range of 3.2 to 17.1 percent of children suffering from mild to severe hearing impairment; but such a wildly variable estimate makes pinpointing a precise number difficult.

Sound desensitization therapy is one solution proposed by the American Speech Language Hearing Association (ASHA.) In practice, sound desensitization therapy uses noise generators, ranging from barely audible tones to white noise, over a period of time to gradually desensitize individuals with hyperacusis until a tolerance to normal levels of sound is achieved. While a moderate level of success in tinnitus treatment has been reported with sound desensitization, further research into its effects on hyperacusis treatment may be required; particularly in ASD, whose spectrum of sensitivity and behavior can be wildly dramatic.

More commonly, audiologists may suggest the use of noise canceling ear plugs as both a supplement to sound therapies as well as in daily usage for patients with noise sensitivity. Noise canceling ear plugs have been shown to positively affect children with ASD and ADHD who may show sensitivity to human voices in particular. One downside is that while noise canceling ear plugs may provide immediate relief, individuals with noise sensitivity may find their tolerance levels unchanged once they’re removed. As a result, an audiologist or behavioral specialist will often suggest them in conjunction with other therapies.

Auditory integration therapy (AIT) is a relatively recent therapy commonly used to treat ASD which involves listening to filtered music or sounds set at various levels daily for a given amount of time, gradually strengthening noise tolerance levels. While there is some minor evidence that AIT has been proven beneficial, it’s primarily anecdotal to date. Since there has been little scientific research or evidence into the efficacy of AIT, it doesn’t necessarily meet the standards of ASHA adopted practices outside of institutionally approved research protocols.

Conclusion

We’re still worlds away from understanding the exact causes of ASD and ADHD. And while we know some of the characteristics of both, effective therapies are still in development.

That’s chiefly because neither can have universal traits associated with them. Noise sensitivity and hyperacusis may be one of them, but it’s not exclusive to all cases. Nor is noise sensitivity indicative of either. What is exclusive to both ASD and ADHD is that we’re now developing new methods of how to better treat and integrate both conditions. Treatment and integration which will allow individuals with both to be just as productive and successful as those without.

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