Auditory Hypersensitivity and Autism Spectrum Disorders: An Emotional Response by Dr. Jay Lucker and Alex Doman

7/31/2019 Auditory Hypersensitivity and Autism Spectrum Disorders: An Emotional Response by Dr. Jay Lucker and Alex Dom

1/6www.autismone.org REPRINTEDWITHPERMISSIONAUTISMSCIENCEDIGEST:THEJOURNALOFAUTISMONEISSU

audiTory hypersensiTiviTy and

auTism specTrum disorders

One concern parents and proessonals ma havewth chld ren who have been dag nosed wth anautsm spectrum dsorder (ASD) s that some othese chldren cannot tolerate lstenng to certansounds. Ofen, parents observe that the chldren put

ther hands over ther ears, run awa rom sounds,or sometmes lose control o ther behavors nthe presence o certan sounds. Tese chldren areofen dented as havng auditory hypersensitivit yor hypersensitive hearing.1-10 Although concernabout audtor hpersenstvt has been especallocused on chldren on the autsm spectrum, mannonautstc chldren also present wth behavorslabeled as audtor hpersenstvt.2-4,6-9

For man ears, experts ocusng on audtorhpersenstvt and treatment or problems ohpersenstve hearng looked at ths phenomenonas an audtorsstembased problem nvolvng

abnormal hearng but not hearng loss. Somedened audtor hpersenstvt as a n overreactonto sounds that should (over tme) no longer warrantsuch responses. However, recent research has ledus to a better understandng o what ma be gongon n chldren who have hpersenstve hearng. Anunderstandng o possble mechansms can assst us

n provdng more approprate nterventons to helpchldren overcome audtor senstvt problems.Ts artcle dscusses audtor hpersenstvt wtha ocus on the current state o our understandng othe problem and treatment or such problems.

hearing versus percepTion

and audiTory processing

Genercall, audtor hpersenstvt usuall reersto a person who s consdered overl senstve tosounds, especall loud sounds. Tere are manwho mght th nk that chld ren wth audtor hpersenstvtes, thereore, have hearngrelated

audiTory

hyPersensiTiviTy

and auTismsPeCTrum disorders:

an emoTional resPonse

By JAy R. LUCKER, EDD, CCC-A/SLP, FAAA, AND ALEX DOMAN

problems. However, the ollowng three dentoclar that audtor hpersenstvt has to do wour perception o sound rather than our hearingsound:

1 One denton o audtor hpersenstvts abnormall senstve hearng n whch

normall tolerable sounds are perceved asexcessvel loud.11

2 Another denton s an ncreasedsenstvt to sound percepton, subjectven nature.12

3 in dscussng audtor hpersenstvt,Gomes and colleagues5 cte Kanner,13who dscu sses chld ren on the autsmspectrum as havng aversions to certanloud sounds rather than havng problemshearng or lstenng to loud sounds.

Abstract

Many children diagnosed with an autism spectrum disorder are described as having auditory hypersensitivities . Thispaper describes auditory hypersensitivities, the systems involved in hypersensitive hearing, methods or evaluatingauditory hypersensitivity in children, and possible treatments. Auditory hypersensitivity involves the non-classicalauditory system and is an emotional response to sound rather than an auditory response. Children described asbeing hypersensitive to sound have negative emotional reactions to sounds and situations in which the soundsare present. It is possible to desensitize these negative emotional reactions and reprogram the emotional memorysystem so that children are no longer rightened by sounds.


2/6AUTISMSCIENCEDIGEST:THEJOURNALOFAUTISMONEISSUE04REPRINTEDWITHPERMISSION www.autismone.org

aLex DOManis ounder and CEO o AdvancedBrain Technologies. He is also a bestsellingauthor, producer, and speaker. He has ocused hiscareer on sound, music, and technology and theircapacity to improve brain health and perormance.His credits include being co-producer oMusic forHealing at the Speed of SoundandMusic forBabiesas well as executive producer, creator, orcollaborator on more than 50 other music albumsand products includingSound Health, Musicfor the Mind, BrainBuilder,andThe ListeningProgram.Doman is coauthor o the bestsellingbook Healing at the Speed of Sound.See alsowww.dvdbi.om .

Jay r. LucKer, eDD, ccc-a/SLP, faaa,is an associate proessor in the Department oCommunication Sciences & Disorders at HowardUniversity in Washington, DC. He is also a certifed/licensed audiologist and speech-language pathologistspecializing in auditory inormation processing disorders(APD). Dr. Lucker is president, coounder, and chair o the

board o the National Coalition on Auditory ProcessingDisorders (NCAPD). See also www.pd.og.

AUTISMSCIENCEDIGEST:THEJOURNALOFAUTISMONEISSUE04REPRINTEDWITHPERMISSION www.autismone.org



All o these descrptons and dentons look ataudtor hpersenstvt as a problem wth behavor(percepton) and not wth hearng. As thesedentons ndcate, the phenomenon we reer to asaudtor hpersenstvt s not a problem wth theaudtor sstem beng hpersenstve but wth theperson beng hpersenstve to sounds. We wll takeup the topc o wh a person becomes overl senstveto sound though the hearng or audtor sstem sunctonng perectl normall as we proceed.

Hearingcan be descrbed as senstvt to sounds.Better stated, t s our ablt to recognze that asound has entered our ears and traveled to our branswhere the sound s heard or regstered as present.Tus, hearng s the recognton o the presenceo a sound. Ts recognton does not mean weunderstand the meanng o the sound nor does tndcate that we have an percepton o the sound.

Perception s our cogntve ablt to gve meaningto a sound. in contrast to hearng, whch s justthe awareness o the presence o sound, when weperceve a sound, we make a cogntve decson asto what that sound means. Consder the ollowng

example. you are sttng at home and ou suddenlhear a rappng sound. it comes as tap, tap, tap, wththree taps or bangs that are o the same exact ptchor requenc, o the same loudness or ntenst,each lastng the same length o tme wth the sameshort gap o quet between each o the taps. youraudtor sstem merel hears these sounds andnotes the pattern o sounds. However, when oureact to the sounds, get up, go to the door, ask whos there, and open the door, our cogntve decsonmakng sstem has taken that audtor pattern andmade sense out o t. Recognzng that the tap, tap,tap s a unque pattern that ou have heard beore,

ou perce ve that ou have a memor trace or t hspattern. Tat memor trace leads ou to knowwhat the pattern means . you even have a na me ort, callng t knockng on the door, and ou havea mental mage that when ths pattern occurs, oushould respond b seeng who s at the door. Tspercepton occurs through a seres o processes wereer to asauditory p rocessing.

processing in audiTory

hypersensiTiviTy

Consder that ou are a lttle chld, and ou hear

certan sounds. your processing systems make the

decson that the sounds are rghtenng, annong,and ver loud. What do ou do? you ma cr, runawa, hde, or merel tremble n ear. Ts mabe a normal response n a ver oung chld. Terghtenng sound strkes our cogntve sstem, andou react n a negat ve emotonal wa. What happensnext could be that the memor o ths rghtenngsound s stored so that the pattern o sound, whenheard, s a gan perceved as a r ghtenng sound. youma react wth ear not onl toward the sound butalso toward the stuaton n wh ch the sound occursand the thng makng the sound. Over tme, just asPavlovs dogs began to salvate at the sound o thebell wthout ood beng present, the rghtenngsound tsel ma no longer be needed to elct thenegatve emotonal memor assocated wth thesound. Te stuaton or thng that made the soundalso can set o our ear responses. Eventuall,somethng called generalzaton occurs so thatsmlar stuatons or objects smlar to the onesthat made the orgnal rghtenng sound also wllelct the negatve emotonal reactons. Ts s howan ntal audtor-based hpersenstvt becomes

a more general hpersenstvt to sound and thestuatons n whch the sound occurs.

Audtor processng nvolves at least sxntegrated sstems.6,14 Tese sstems nclude:

Te audtor sstem tsel Te cogntve decson makng sstem Memor (ncludng emotonal memor) Te emotonal sstem Language sstems Sensor regulaton sstems

Over tme, the audtor sstem tsel ma not be

that mportant n the processng o loud sounds,and we ma nstead draw on the other sstems.Tat s, we mathink that a sound wll be loud andrghtenng (cogntve decson makng sstem);we marememberthe wa the orgnal sound scaredus (memor); we ma want to avod sounds andthe stuatons n whch these rghtenng soundsoccurred (emotonal sstem); or we ma have anautonomc nervous sstem reacton, whch t pcallnvolves what are calledfght or ightresponses. Forexample, n antcpaton o the rghtenng sound,we ma lose control o our behavor and tr to

run awa (ght); we ma put up a strong, negatve

Hearng s the recognton o the presence o a sound. Ts recognton does notmean we understand the meanng o the sound nor does t ndcate that we have anpercepton o the sound.Perception s our cogntve ablt to gve meaningto a sound.in contrast to hearng, whch s just the awareness o the presence o sound, when we

perceve a sound, we make a cogntve decson as to what that sound means.

emotonal ght to avod the sounds (ght); or ma retreat nto ourselves seekng to cal m ourselthrough behavors such as rockng or runnaround n a crcle (another tpe o ght response

Tus, a hpersenstve reacton can occurantcpaton o a sound, even the sound tselabsent. Tese reactons can also occur when hear a sof, nonthreatenng sound our processsstem persuades us that the stuaton or soundor wll be the same as a prevousl heard soundths wa, we can enter nto automatc, negatve, aemotonall reactve behavors and maladaptresponses. Tese maladaptve responses behavoral reactons that result rom our ear osound and our ear that the sound ma occur wthowarn ng. Behavors are consdered malad aptand napproprate when the perpetuate even strengthen the chlds ear. For exampsome chldren demand to be removed rom avod partcpatng n certan stuatons. Othchldren go rom wearng earplugs (or earmusheadphones) n a ew stuatons to wearng earpluall the tme or wearng ear plugs and avodng cert

stuatons. Ts tpe o maladaptve response nonl can lmt a chlds experences but also donot take care o the problem because t ocuses treatng the audtor/hearng sstem rather ththe real underlng sstems nvolved.

classical and non-classical

audiTory paThways

Let us revew the basc audtor sstem, whchalso known as the classical auditory system. Ts sststarts wth the ear. Te ear has three parts beenterng the central audtor pathwas, whch also called the central audtor nervous sst

(CANS). Te three parts o the ear nclude:

1 Te outer ear: Te outer ear ncludes what see and call the ear, whch s reall t he pnnaaurcle. Te outer ear collects sound and brnt to the ear drum or tmpanc membrane.

2 Te mddle ear: Te tmpanc membrabegns the mddle ear, whch also nvolthe three bones o the mddle ear: malleushammer, ncus or anvl, and stapes or strrTe basc uncton o the mddle ear s to del

the sound sgnal to the nner ear or cochlea.



3 Te nner ear or cochlea: Te nner ear orcochlea s a udlled structure that alsohouses the sensor cells o hearng called thehar cells. When the ha r cells are appropratelstmulated, the release neurochemcals to theaudtor nerve or eghth nerve.

Te eghth nerve transmts the neural sgnal to thelow branstem where nerve statons pck up thesgnal, do some processng o ther own, and transmtthe processed sgnal to the upper branstem, where tthen travels to a regon o the thalamus (just belowthe cortex o the bran). Afer some processng n thethalamc area, t he neural sgnal s transmtted to theaudtor centers o the cortex on the rght and lefsdes, whch connect wth each other va a str ucturecalled the corpus callosum. Once the neural sgnal sn the audtor centers o the bran, t can be relaedto varous other centers o the bran such as thelanguage center (or lngustc understandng), thememor centers (to remember the audtor patternswe hear), and the cognt ve decson mak ng center s(so that we can make decsons about the sound

patterns we hear). (Tere are man good webstesand basc anatom books that provde more ndepth descrptons o the classcal audtor pathwa.See, or example, the basc audolog textbook bMartn and Clark, 2011.15)

it was not untl the earl 2000s that Moller andassocates descrbed what the called the non-classical auditory pathways.16,17 Essentall, thesenonclasscal pathwas begn wth the eghth nerveas do the classcal audtor neural pathwas. Wherethe classcal pathwas eventuall connect wth theaudtor centers o the cortex, however, the nonclasscal pathwas make connectons wthn the

regon o the bran called the lmbc sstem andthe cerebellum. Te lmbc sstem s an old neuralsstem hdden deep nsde the cortex o the bran.it houses a number o structures, two o whch are

lkel nvolved n audtor hpersenstvt. Onestructure nvolves our emotonal reactons andleads to behavors assocated wth the ght or ghtresponse. Another s the amgdala, whch s thecenter o emotonal memores.

Moller and Rollns16 demonstrate that the nonclasscal audtor pathwas are hghl actve n oungchldren and become suppressed as we get older. its not surprsng to see a oung toddler rghtenedb a loud, unexpected sound. Ofen, the toddlerwl l cr and demonstrate other negatve emotonalreactons to such a sound. Over tme, toddlers learnto nhbt or suppress the nonclasscal pathwasso that the ma ntall react to a loud sound butthen gan control and show onl annoance at thesound. As chldren learn that the are able to controlther reactons to annong sounds, the come tounderstand the sounds, the thngs producng thesounds, and the stuatons n whch the soundsoccur. Te learn that the have no need to avod orbe arad o such sounds and stuatons.

What a chld s not able to suppress the nonclasscal audtor sstem? What the nonclasscal

sstem remans hghl actve long afer t s no longerneeded or normal unctonng? Tese questonsand the recent nterest n nonclasscal pathwas haveled to descrptons o how the nonclasscal pathwasma contrbute to the behavors and reactons wesee n chldren wth audtor hpersenstvt.6,18

investgators hpothesze that chldren wthsensor processng problems, ncludng chldrenon the autsm spectrum, mantan actvt o thenonclasscal audtor sstem.6,17,19 From thsperspectve, the negatve emotonal memores andreactons to sounds (and stuatons n whch suchsounds have occurred n the past) become strongl

condtoned nto these chldrens lmbc sstems.Generalzaton has occurred, so that the chldrenare rghtened b thngs that mght make loudand annong sounds as well as stuatons n whch

such sounds mght occur, even the sounds arehghl unlkel to actuall occur. Ts leads to thephenomenon we call audtor hpersenstvt.

evaluaTion oF audiTory

hypersensiTiviTy

pcall, a person s dented as benghpersenstve to sound through checklstsor descrptons o behavors.5,20,21 However,these dagnostc tools are hghl subjectve. Aless subjectve method or assessng audtorhpersenstvt needs to be developed. One o us(JRL) descrbed an approach (usng earphones)that used three methods normall emploed baudologsts to t the maxmum loudness o hearngads and cochlear mplants or chldren: standardaudologcal tolerance, uncomortable loudness(UCL), and threshold o dscomort (D).6 in thsstud, onl 32% o chldren dagnosed wth an ASDcould not tolerate extremel loud sounds. WhenGomes and colleagues5 used a smlar approach(wth sounds presented through loudspeakers ratherthan earphones), the ound that onl around 24%

o ther subjects could not tolerate the loud soundsused. Tus, both studes ndcated that chldrendented wth ASD overwhelmngl are able totolerate loud sounds when the sounds are presentedn controlled, standard, audologcal (.e., hearngtest) condtons. Ts suggests that the 68% to 76%o chldren n the two studes who could tolerateloud sounds are lkel to have emotonal memorreactons to loud sounds rather than contnuedaudtorbased reactons. For these chldren, whorepresent the overwhelmng majort o ASDchldren wth audtor hpersenstvtes, thetreatments that we recommend below are lkel to

brng about postve outcomes much more qucklthan or chldren who react strongl to the presenceo loud sounds. Te latter group o chldren can alsobe helped, but t ma take a longer perod o tranng.

Te bass o desenstzaton tranng, as the name suggests, s to desenstzethe emotonal and nonclasscal audtor sstems so that the no longer reactnegatvel to loud and annong sounds, the thngs that make the sounds, and

the stuatons n whch such sounds ma occur.



TreaTmenTs For audiToryhypersensiTiviTies

wo types o treatments have been tred to helpchldren wth audtory hypersenstvty. Te rst groupo treatments ocuses on the problem as an emotonal-behavoral problem based on learned behavors, whch

we sugge st s due to condton ng va the non-cl asscalaudtory pathways. Ts set o treatments ocuses on

what s ca lled adesensitization approach.Te second group o treatments ocuses on listening

wthout ormal desenst zaton tran ng. in the past ,ths second treatment approach was thought to

work by chang ng the audtory system. More recent

nterpretatons suggest that t, too, works throughthe non-classcal audtory pathways, usng specallymoded sound to reprogram lmbc system reactonsand thereby reteach the bran.

DESENSItIzAtIoN trAININg

Te bass o desenstzaton tranng, as the namesuggests, s to desenstze the emotonal and non-classcal audtory systems so that they no longer reactnegatvely to loud and annoyng sounds, the thngsthat make the sounds, and the stuatons n whch suchsounds may occur. A better term or desenstzaton

tranng mght be systematic desensitization because theapproach uses a systematc, organ zed method to get thechld to stop reactng negatvely to loud a nd annoyngsounds. Descrptons o specc desenstzatontranng programs or audtory hypersenstvtyn chldren wth ASD ndcate that a program osystematc desenstzaton can succeed n helpngchldren not to ear loud and annoyng sounds.22,23Koegel and colleagues22 also demonstrated thatchldren were able to tolerate annoyng sounds up toone year afer completng desenstzaton tranng, and(accordng to parents) ther tolerance generalzed toother sounds prevously descrbed as rghtenng but

not desenstzed durng tranng.Systematc desenstzaton nvolves placng the

chld n a comortable, stress-ree stuaton and slowlyand careully ntroducng the sounds to whch thechld s hypersenstve. in ths type o tranng, thesounds are usually presented at low levels, and theloudness o the sound s brought up to a normal levelover tme. Te chld s then presented wth t he soundor ncreasngly longer perods o tme. Over thecourse o such tranng, the chld s brought closer andcloser to the sound and stuaton n whch the sound sused, untl, n the end, t he chld s able to engage n the

stuaton n the presence o the prevously rghtenng

sound. Te sound may stll be annoyng, but the chldno longer loses control o hs or her behavor and nolonger presents wth negatve emotonal reactons tothe sounds.

Desenstzaton methods seem to be worth tryngor many chldren who have audtory hypersenstvtes.However, ths approach requres that chldren be

wll ng to lsten to the nta l presentat ons o thesound. Ts s where lstenng methods may be helpul.

We recommend that lsten ng methods be consderedas the rst level o nterventon or all chldrendented wth audtory hypersenstvtes. Oncelstenng and loud sounds are no longer rghtenng,

desenstzaton tranng can be tred, necessary.

lIStENINg mEthoDS

Ts type o tranng nvolves a more passve methodto desenstze the lmbc system and reprogram theemotonal memory system, wth the am o makngsounds somethng one desres to lsten to rather thanavod. Te lstenng method descrbed here usesspecally chosen sounds and musc, typcally classcalmusc. Te sounds or musc are acoustcally moded tolead the chld to react less negatvely to sounds and, thus ,reduce the chlds hypersenstvty. Although a number

o lstenng methods have been developed, we ocus onone specc method called Te Lstenng Program(LP). A traned provder, usually a proessonalsuch as an occupatonal therapst or speech-languagepathologst, conducts the LP tranng. Te provdertypcally establshes the actual program and protocolbased on the ndvdual chlds needs and carres out thetranng n the home or at school.

When lsten ng usng LP, t s thought that thesound sgnal travels along both the classcal and non-classcal audtory pathways. Lkely conrmng thsassumpton, one o the rst outcomes that parents,educators, and proessonals ofen see n chldren

undergong LP tranng s that the chldren arecalmer. Ts s a good ndcator that the lstenng hastapped nto the emotonal areas o the lmbc system

va the non-classca l audtory pathways . Over thecourse o tranng, chldren ofen are also reportedto be more attentve to sounds, better able to detectsounds they hear, and more communcatve whencommuncaton s verbal, lkely because t hey are moreopen to lstenng. As the tranng proceeds, the chldcontnues to relax and become calmer when lstenng.

We hypothe sze th at th s s becau se a reprogra mmngo emotonal memory n the amygdala s occurrng.Te tranng reprograms lstenng and sounds as

postve experences. When the chld then hmsel or hersel n a real-world stuaton and hesounds that may have been rghtenng or annoyn the past, t he tranng allows the chld to process sounds n more neutral man ner.

For many chldren, the use o a program suas LP s sucent to reprogram ther systemsthat sound s no longer rghtenng. Ts does mean that loud and annoyng sounds may not stllrrtatng. Te chld may stll react verbally sayng the or she does not lke such sounds or the stuaton

whch the sou nds occur. Afer LP tran ng, howevthe chld wll not lose control o hs or her behav

in addton, the chld may be more wllng to lstenparents or teachers, who can model desenstzatonsayng, Well, the sound s annoyng, so lets move ohere, or i we wal k more quckly toward (our goal)can get away rom havng to hear that sound. Ttwo statements model approprate behavors that ocan use when n an annoyng lstenng stuaton.

conclusion

As we have shown, what we prevously beleved wan audtory or hearng-based problem can nstbe understood as a problem o negatve emoto

reactvty and programmng o negatve memorespecc sounds and the stuatons n whch the sounoccur. Ts negatve programmng occurs va non-classcal audtory pathways, whch may remmore actve n some chldren, especally those on autsm spectrum. Once we better understand waudtory hypersenstvty s, we can look at what cbe done to retran the non-classcal audtory systso that chldren wll no longer be hypersenstvesounds. We can derentate chldren who haveoverly actve non-classcal audtory system rthose who have learned to suppress the non-classaudtory pathways. Furthermore, there are t reatme

to help reprogram the emotonal and non-classaudtory systems so that a chld can become mable to tolerate prevously rghtenng sounds. Atreatment, the sounds merely become annoyto the same degree that they mght annoy mpeople wthout audtory hypersenstvtes. O two therapy approaches dscussed, we recommethat lstenng tranng be used as the ntal approaTs can allow the chld to be more successul wsubsequent desenstzaton tranng. Desenstzatmay then become somethng that the chld routnpractces n everyday stuatons rather than a spetherapeutc approach.

What we prevousl beleved was an audtor or hearngbased problemcan nstead be understood as a problem o negatve emotonal reactvt

and programmng o negatve memores to specc sounds and thestuatons n whch the sounds occur.



1. Baranek GT, Boyd BA, Poe MD, David FJ, Watson LR. Hyperresponsive sensor ypatterns in young children with autism, developmental delay, and typicaldevelopment.Am J Ment Re tard. 2007 Jul;112(4):233-45.

2. Geffner D, Lucker JR, Gordon A. Auditory processing skills in ADD children preand post auditory integration training. Paper presented at the April 1994 annualconvention of the New York State Speech-Language-Hearing Association,Kiamesha Lake, NY, 1994.

3. Geffner D, Lucker JR, Gordon A . Reviewing research and controversiessurrounding AIT. Advance for Speech- Language Pathologist s and Audiologis ts.1996;6(17):20-1.

4. Geffner D, Lucker JR, Gordon A, DiStasio D. Auditory processing skills and auditoryintegration training with ADD children. Poster session presented at the November1994 annual convention of the American Speech Language-Hearing As sociation,New Orleans, LA , 1994.

5. Gomes E, Rotta NT, Pedroso FS, Sleifer P, Danesi MC. Hipersensibildade auditivaem crianas e adolescentes com transtorno do espectro autista (translated as:Auditory hypersensitivity in children and teenagers with autism spectrum disorder).Arquivos de Neuro- Psiquiatria . 2004 Sep;62(3).

6. Lucker JR. Helping Children with Auditory Processing Disorders. 2011. [DVD andCD recordings available at www.pesi.com]

7. Lucker JR, Geffner D. Using AIT with ADD children.Advance for Speech- LanguagePathologists and Audiologists. 1994;4(6):3.

8. Lucker JR, Geffner D, Gordon A. Three years experiences with AIT. Newsletter ofthe ASHA Child Language Special Interest Division. 1996 Feb, pp. 3-5.

9. Lucker JR, Geffner D, Gordon A, Rampaul M. Efficacy of AIT with children havingattention deficit disorders. Poster session presented at the 1995 annual conventionof the American Speech-Language-Hearing Association, Orlando, FL, December1995.

10. Stiegler L, Davis R. Managing sound sensitivity in individuals with ASDs. The ASHALeader. 2011 Jan ;16(1):5-7.

11. Stach BA. Comprehensive Dictionary of Audiology Illustrated. Baltimore: Williams& Wilkins, 1997, p. 102.

12. Mendel LL, Danhauer JL, Singh S. Singulars Illustrated Dictionary of Audiology. SanDiego, CA: Singular Publishing Group, Inc., 1999, p. 102.

13. Kanner L. Autistic disturbances of affective contact. Nerv Child. 1943;2(2):217-50.

14. Lucker JR. What are auditory processing disorders? In H Edell, JR Lucker, LAlderman (Eds.), Dont You Get It? Liv ing with Auditory Learning Disabiliti es (pp.7-22). Clearwater, FL: Shadow Publishing, 2008.

15.Martin FN, Clark JG. Introduction to Audiology, Eleventh Edition. NeedhamHeights, MA: Allyn and Bacon ( Division of Pearson), 2011.

16. Moller AR, Rollins PR. The non- classical auditory pathways are involved in hearingin children but not adults. Neurosci Lett. 2002 Feb;319(1):41-4.

17. Moller A, Kern JK, Grannemann B. Are the non-classical auditory pathwaysinvolved in autism and PDD? Neurol Res. 2005 Sep;27(6):625-9.

18. Musiek F, Mohanani A, Wierzbinski E, Kilgore G, Hunter J, Marotto J. The non -classical pathway: too great to be ignored. Hear J. 2011 Oct; 64(10):6,8.

19. Gomot M, Giard MH, Adrien JL, Barthelemy C, Bruneau N. Hypersensitivit y toacoustic change in children with autism: electrophysiological evidence of left frontalcortex dysfunctioning. Psychophysiology. 2002 Sep;39(5):577-84.

20. Dunn W. Sensory Profile. San Antonio, TX : Psych Corporation, 1999.

21. Khalfa S, Dubal S, Veuillet E, Perez-Diaz F, Jouvent R, Collet L. Psychometricnormalization of a hyperacusis questionnaire. ORL J Otorhinolaryngol Relat Spec.

2002 Nov-Dec;64(6):436- 42.

22. Koegel RL, Openden D, Koegel LK. A systematic desensitization paradigm to treathypersensitivity to auditory stimuli in children with autism in family contexts. Res PractPersons Severe Disabl. 2004;29(2):122-34.

23. Norea AJ, Chery-Croze S. Enriched acoustic environment rescales auditorysensitivity. Neuroreport. 2007 Aug;18(12):1251-5.

rEFErENCES

Documents

Auditory Hypersensitivity and Autism Spectrum Disorders: An Emotional Response by Dr. Jay Lucker and Alex Doman