Autism Hypersensitivity Research
In the 1980 publication DSM-III, the American Psychiatric Association diagnostic criterion for
autism diagnosis, specifies, delayed language, irregular speech, unusual environmental conduct
and situational cognisance as the fundamental behavioural criteria for diagnosis of what was then
known as infantile autism.1 The APA has since then has significantly diversified the process in which
diagnosis of autism is completed. DSM-V published in 2013 instead provides a notably less rigid
diagnostic framework, with the inclusion of associated disorders and severity specifiers attached to
individual cases of diagnosis, building on the ideology that autism is a spectrum of conditions. 2 For
example, what would previously be a diagnosis of infantile autism, might now be a diagnosis of
'moderate – severe autism spectrum disorder with global developmental delay and stereotypic
movement disorder'.
An important addition in DSM-V is criterion B-4, 'Hyper- or hyporeactivity to sensory input or
unusual interest in sensory aspects of the environment.'3 Specifically individuals may display
irregular responses to sound, light, touch and olfactory stimuli when compared to their
neurotypical peers. This reaction to stimuli can often manifest as obsessive and repetitive
behaviour patterns surrounding specific properties of the sensory environment.4
Much of the research, case studies, analysis and conclusions within this essay will heavily feature
the hyper-reactive properties outlined in DSM-V's autism spectrum disorders criterion B-4. It is
synonymous with sensory overload, sensory avoidance, information processing, attention span,
environmental engagement and the ability to remain present in audio-visual centric environments
such as those found in music technology education.
Sensory overload is when one or more of the senses is overwhelmed by environmental sensory
stimuli,5 typically triggering passive and active avoidance behaviour responses. Passive responses
can be observed as covering ears, closing eyes, loud vocalisations and self-stimulatory movement.
An active behaviour response can be sensory avoidance, described by Dr. Winnie Dunn in Dunn's
model of sensory processing as a self-regulation strategy where by an individual attempts to
remove themselves from the source of high stimulus.6 Dunn identifies this as an active attempt to
control the level of sensory input an individual is receiving, particularly if the nervous system can
not comfortably handle the level of information processing required to remain present in the
environment.7
An autistic adult with hypersensitivity describes the phonophobic response their body has to
alarm sounds. 'Anything that has that sound, even for just a few seconds, is enough to make my
heart jump, my whole body shudder, and my hands smack against my ears. When the fire alarm
went off at elementary school, I would end up huddled in a ball crying.'8
1
. American Psychiatric Association. Diagnostic And Statistical Manual of Mental Disorders: DSM-III.
1980. 88.
2
. Autism as a spectrum disorder/spectrum disorders explained
3
. American Psychiatric Association. DSM-5. 50.
4
. American Psychiatric Association. DSM-5. 54.
5
. Wendy Lawson. Sensory issues in autism, Eastbourne: East Sussex County Council, 2007. 9 – 10.
6
. Winnie Dunn, “Supporting Children to Participate Successfully in Everyday Life by Using Sensory
Processing Knowledge,” Infants & Young Children 20, No. 2, 85.
7
. Dunn, “Supporting Children to Participate Successfully in Everyday Life,” 86.
8
. Wordpress, “An Autistic’s experiences with Fire Drills”. E The Third Glance (blog) June 29, 2013.
Withdrawal behaviours as a result of overstimulation can be a direct result of biologically induced
physical discomfort. Various neuroimaging departments at Osaka University conducted studies on
21 randomly selected male adolescents with a diagnosis of ASC and hypersensitivity. Concluding
that all participants had profound biological differentiation in auditory processing to their
neurotypical peers.9 Identifying that due to marked delay in neurological processing, specifically
pinpointing M50 dipole moments significantly increased when compared to sensory typical control
groups.*appendix a* The journal ascertains, 'individuals perceive innocuous sounds as painful and
frightening noise; and in some cases, those sounds may be perceived as phobic stimuli and result
in radical behavioral responses'.10
In 2008 a study was conducted on the audible and acoustical properties of special needs
classrooms by autism architectural specialist Dr. Magda Mostafa. The study identified that when
environmental noise factors were regulated, specifically reduced, autistic children's behavioural
temperament, attention span and verbal response time improved significantly. Echo ratio of the
environment was reduced by 39% and the average ambient background noise was lessened from
65.5dB to 52.5dB. The study identifies that the children's willingness to communicate and
attention span increased more so when present in progressively quieter environments, the
establishments soundproofed speech room specifically.11
The children were better able to identify, recognize, imitate and verbalize in
the soundproofed speech room. On average the study group exhibited an
increase of more than 3 times their original attention spans. They exhibited
a gradual increase in their attention span median from 44 to 58 to 72 to
142.50 seconds over the 12 week period.12
A comparative study published by Shireen M. Kanakri in the American Journal of Paediatrics found
a similar relationship between the reduction of decibel levels within ASC classrooms and noise
induced behaviour responses such as covering ears, loud vocalisations, repetitive motor action and
hitting peers. Observing that these behaviours were significantly less prevalent in students when
the ambient noise in the environment was at 55dB. Sensory avoidance behaviours significantly
increased when levels reached 70dB or more.13 As a measure, the Health and Safety Executive
defines 40db as a quiet office and 70dB as soft radio music in homes.14
Accessed Apr 21, 2019. https://thethirdglance.wordpress.com/2013/06/29/an-autistics-experiences-withfire-drills/.
9
. Junko Matsuzaki J, et al., “Progressively Increased M50 Responses to Repeated Sounds in
Autism Spectrum Disorder with Auditory Hypersensitivity: A Magnetoencephalographic Study,”
PLoS ONE 9, no. 7 (2014): 4.
10
. Junko Matsuzaki J, et al., “Progressively Increased M50 Responses to Repeated Sounds in
Autism Spectrum Disorder.” 4.
11
. Magda Mostafa, “An Architecture for Autism: Concepts of Design Intervention for the
Autistic User,” International Journal of Architectural Research 2, no. 1 (2008) : 193, 197.
12
. Mostafa, “An Architecture for Autism: Concepts of Design Intervention for the Autistic
User,” 198.
13
. Shireen M. Kanakri. “Spaces Matters: Classroom Acoustics and Repetitive Behaviors in
Preschool Children with Autism,” American Journal of Pediatrics, 3, no. 6 (2017), 91.
14
. Health And Safety Executive, “Sound advice Control of noise at work in music and
entertainment,” 2008, 11.
Kanakri notes the classrooms monitored in the study adhered to the Acoustic Society of America's
American National Standard Acoustical Performance Criteria. The United States authority on
moderating acoustics of rooms in special educational establishments. The ASA advises ambient
noise levels of empty SEN classrooms at ≤ 35dB, and reverb times of ≤ 0.6 seconds respectively.15
Similarly the United Kingdom's equivalent regulatory authority of the acoustics of classrooms and
music education spaces, the Department of Education's Building Bulletin 93. Requires ambient
noise of empty SEN calming rooms to be ≤ 35dB16 *appendix 2* and the reverberation time to be ≤
0.6s.*appendix 3* Furthermore this requirement is identical for primary school classrooms and
music rehearsal spaces, which fulfil crucially different purposes.** It is not possible to discern what
criteria was used to calculate the requirements stated as there is no reference to analytical data for
justification of proposed figures.
Where the DfE's statements prove inconclusive to their effectiveness, Mostafa's research confirms
that interventions conducted in a soundproof speech room saw an significant jump in children's
emotional well-being, ability to communicate, mimic and recognise also dramatically increased.17
Isolation spaces such as soundproof speech rooms offer significantly greater noise and reverb
reduction than DfE and ASA guidelines, with industry standard isolation spaces typically achieving
further ambient noise reductions of 20dB – 40dB and reverb times of≤ 1.4s.18
Ethan Jones, a man of 25 who has been visiting the Nordoff Robins Music Therapy Centre in New
York for over 15 years, describes that as a young boy he would sit underneath the family home
piano because the acoustics sounded much better to him there, describing it as a 'sensory
hideout', where he developed the comfort to learn to sing.** Notably Jones learned to sing long
before he could speak, Jones's therapist and mother Maria Hodermarska explains how learning to
sing was critical in Jones developing language, confidence, artistic expression and fundamental
emotional well-being.**
This accumulation of statistical data on the prevalence sensory processing differences in ASC, case
studies such as Ethan's and supporting findings from Mostafa's and Kanakri's evidence-based
investigations, highlights that by further considering the audible properties of an environment,
significant improvements can be made to the quality of musical engagement for children with ASC
notably those who have significant sensory processing differences.
15
. Acoustic Society of America. American National Standard Acoustical Performance Criteria,
2010. **
16
. Department for Education, Acoustic design of schools: performance standards, DFE-BB93,
2015, 19.
17
. Mostafa, “An Architecture for Autism: Concepts of Design Intervention for the Autistic
User,” 198.
18
. “Silent Space Isolation Booth 2.4m x 2.4m,” Advanced Acoustics. Apr 9, 2019, accessed Apr
9, 2019, https://www.advancedacousticsuk.com/download/SS2424.pdf.fe6c9a5e0f2d8982efff3d1e8de7726e