| There has
long been acceptance of the fact that people with
autism demonstrate abnormal responses to sensory
stimuli. Some professionals though believe that
people with autism actually experience sensory stimuli
in an unusual way: and that the bizarre perceptual
experiences actually cause the 'abnormal' reactions.
This has led to the idea that, when severe, such
perceptual problems contribute to confusion, social
withdrawal, communication and cognitive problems,
stress and obsessive-compulsive behaviours.
Whether the latter idea is true or not has yet
to be determined but the evidence of abnormal
perceptual experiences has come, over many years,
from people with autism themselves. They repeatedly
comment that their tactile, auditory and visual
experiences are, in some way, different to those
of most people. Unfortunately though some professionals
remain sceptical, and continue to dismiss such
accounts as anecdotal.
These conflicting ideas result in confusion and
create considerable doubt about the efficacy of
treatments said to alleviate the sensory problems.
Is there any way to clarify this confusion? Certainly
if such problems actually exist it should be possible
to describe them and assess them in some way:
as is now possible for both the auditory and the
Apart from deafness and partial hearing loss there
are several less well known auditory problems
found both in the general population and, to a
greater extent, in people with dyslexia and autism.
Auditory dyslaterality - hearing some sounds Slowed
auditory perception. Problems
well with one ear whilst hearing them only of
interpretation as letters are lost or
partially or not at all with the other ear. their
sequence is misheard.
Inability to habituate to (cut out) particular
Loss of concentration in situations
sounds (as most of us do e.g. when sleeping with
background noise - especially
near a noisy road). social situations. Disrupted
'Supersensitive' hearing - found in the child
Generally not perceived as a problem
who can hear a 'silent dog whistle' or the 'far
end' but may be factor in hyperacusis -
of a telephone conversation. (i.e. hypersensitivity
Hyperacusis - often associated with tinnitus.
Avoidance of particular situations. Makes
Stressed by particular sounds that do not socializing,
shopping, travelling etc.
bother other people. Such sounds generally extremely
seem much louder than they actually are
& the person is unable to block them out easily.
The sounds are individual & can include people
eating, television, vacuum cleaners & also
quieter sounds like a zip being pulled. Hyperacusis
is also found in over 40% of people with tinnitus
as well & may prove to be a factor in the
development of some tinnitus.
It is important to note that hyperacusis is different
to an overall hypersensitivity to sound which
is often associated with a lack of certain minerals
and can increase in stressful situations.
Loudness discomfort. The majority of people can
tolerate sounds up to 100 decibels but some people
with autism have a far lower tolerance.
Auditory problems in autism.
Many people with autism have one or more of these
auditory problems. These problems can leave the
child unable to concentrate properly as extraneous
sounds constantly impinge upon him. Thus when
listening to others the child may hear a single
word or two or even a simple sentence but longer
sentences may be 'broken up' by intruding background
noises and the meaning lost: as it is if you try
to listen to a badly tuned radio.
Some certainly have hyperacusis as did Georgiana
Stehli (diagnosed with autism as a child). She
was so badly affected by some sounds that, as
she told her mother, 'The sound was the only thing
that drove me crazy because I was so scared .
. . and sound was going on all the time. It was
hard to get away from it.
(Stehli 1990, p.188)
Small wonder that such problems can lead him
to avoid, run away from, or block out the noises
he dislikes - blocking out many important sounds
as well and thereby losing a valuable aid to learning
Approximately 70% of information about the world
is taken in through the eye. Unfortunately there
are a group of visual perceptual problems (known
by various names such as visual discomfort or
Scotopic Sensitivity - Irlen - Syndrome) which
may remain unidentified by an ordinary eye test
but which, once found, can often be remedied by
the use of tinted lenses.
These perceptual problems affect some 15 - 20%
of the general population and approximately 50%
of people with dyslexia, some of whom also have
conditions such as migraine, allergies or hypoglycaemia.
A family history of migraine, allergies, dyslexia
or hyperactivity is also common.
When the condition is mild the person may learn
to adapt to the difficulties and will experience
few problems apart from headaches or migraine.
Those with moderate problems could have a range
of 'dyslexic' type difficulties when reading or
The following list identifies some of these visual
problems, several of which are linked to poor
coordination between the eyes:
Photophobia - sensitivity to glare Discomfort,
headaches or migraines when reading or
brightness or fluorescent lights. problems when
driving at night. Words 'get lost'
when reading and the paper may appear to glare.
Unexplained loss of visual Sees things as darker
than they actually are - losing
acuity much of the features, fine detail and colour.
An insufficient ability to focus. Impairment
similar to tunnel vision in which a small area
of page is clear but the surrounding area is blurred.
Difficulty in sustaining focus Tires easily when
reading, suffer headaches or eyestrain.
without great effort. Print seems distorted -
running together/moving. The
background may also glare or dominate.
Poor depth perception. Clumsiness, problems when
throwing, catching, judging
height or width, walking down stairs.
Severe visual perceptual problems.
Accounts from people with autism and Asperger's
Syndrome as well as the work of the Irlen Institute
now indicate that such problems may also affect
people with autism and Asperger's Syndrome, causing
a wide range of difficulties which are generally
more severe than those found in dyslexia.
So how things might look to a person who had
severe scotopic sensitivity. Focusing problems
and poor depth perception are relatively easy
to understand but what of photophobia and that
unexplained loss of visual acuity?
You can simulate the effects of photophobia for
yourself by looking at things under a very bright
light. As you will see the features of faces fade
although distinct points such as the nose or a
beard may remain readily identifiable. Background
details will be leeched of colour though making
it more difficult to identify them correctly.
It is easy to see that under some lighting conditions,
people and objects would appear fragmented. Not
only would this make life extremely confusing
and frightening but, in real life, movement and
different lighting conditions would mean that
the 'picture' was constantly changing.
In contrast wearing darken glasses indoors on
a dull day (without putting the lights on) will
enable you to replicate a loss of visual acuity.
Once again you will find that features on faces
become less clear, especially around the eyes,
although a white tooth stands out. The background
details become far less clear and some of features
may merge into each other. This will make it hard
for you to identify the expressions on the faces
or accurately see just where one object ends and
One additional problem was identified by Georgiana
Stehli who saw things as if they were magnified
- a strand of hair looked like a piece of spaghetti
- and could also see lines, shapes and colours
that most other people would have been unaware
of. While the object focused on will seem much
larger than normal, things on the periphery become
blurred or 'lost'. Imagine how weird and confusing
the world must seem if viewed in this way.
Where such problems exist it is easy to imagine
the difficulty of recognizing people and objects
correctly. Could they also explain why people
with autism have difficulties in understanding
the emotions of others and in interpreting body
language? Do they actually see the smile on your
face or your gestures correctly? Doubtful when
you consider that Gunilla Gerland talks of 'people
with blank faces' in her book? Given that similar
problems can leave the person with dyslexia 'word
blind' I would suggest that the more visual severe
problems found in autism could leave the person
What should be done?
There are three options. One is to ignore such
ideas totally, continuing to think in terms of
"abnormal reactions to stimuli". Certainly
it is easy to attribute bizarre behaviours solely
to the problems of autism. And yet - what if the
problems really exist? Would you leave a child
who had a hearing loss or who was short-sighted
to struggle with their problems rather than having
them assessed and treated? Of course not - and
yet that is the implication of this option.
Second is to use various techniques to help the
person learn how to cope with such difficulties
- eg by using earplugs - which is a good idea
when treatment does not exist. However treatment
does exist for both the auditory and visual problems
mentioned. Thus the third and most sensible option
is to have such problems assessed and, where they
are found to exist, to treat them.
How will you know if your child has auditory
While any hearing assessment should include tests
to assess hyperacusis and loudness tolerance it
is worth noting that older children and adults
with autism or Asperger's syndrome may be so adept
at blocking sounds that test results could be
misleading and parents' memories of early childhood
reactions will need to be taken into account.
The checklist below will give you some indication
as to whether or not treatment would be beneficial.
Indications of severe auditory difficulties.
Often ignores sounds/speech but reacts readily
to some noises eg sweetpapers crackling.
May initially be considered deaf.
Speech difficulties - e.g. speech does not develop
(but is not deaf) or development is slow; echolalia;
speaks clearly but only occasionally; consistently
mispronounces some words.
If given two instructions is only able to carry
out one task or does neither.
Dislikes some noises and demonstrates this by:-
putting his hands over/in ears
getting upset or distressed
going into 'a world of his own'
And/or spends a lot of time listening to music
- often quite loudly.
A very light sleeper - wakes easily.
Frightened of some animals - especially household
Seems to hear noises which other people might
not be aware of eg the hum of fluorescent lights,
people breathing etc.
Can often correctly identify distant noises (before
others hear them) or can overhear distant conversations
eg both sides of a telephone conversation
Dislike bathing, haircut's, shaving, teethcleaning
etc. because of the noise of the water, scissors,
Finds mealtimes difficult as dislikes the sound
of people eating
Dislike the sound of a toilet flushing.
Dislikes shops, crowded situations, shopping,
rainstorms, wind, seaside etc.
Learns/concentrates better in quiet surroundings.
Enjoys/seeks music or loud rhythmic noises i.e.
washing machines, vacuum cleaners, lawn mowers.
Enjoys being in control of noisy objects - eg
likes playing with running water, flushing the
Likes/does things that make a noise; squeaking
toys, tearing paper, banging doors etc.
Auditory Integration Training (AIT) was developed
by Dr. Bérard who used it to treat people
who had a wide range of difficulties, including
depression, dyslexia, learning difficulties and
autism; the common link being some type of hearing
AIT still has some critics but the results (many
of which can now be found on the Internet) generally
indicate that it can have positive benefits. Even
though the method by which it works is not fully
understood, treatment effectively 'retrains' the
hearing, correcting some hearing distortions and
undersensitivity whilst desensitizing those with
hyperacusis and increasing tolerance of previously
uncomfortable noise levels.
The benefits of AIT
While the results are obviously dependent
on the initial problems they include:
· improvements in the ability to listen,
concentrate and learn.
· increased sociability and communication
· reduced hyperactivity - less impulsive
· improved behaviour, clearer speech.
· increased concentration, better memory
How do those who have undergone treatment actually
feel about it? Let them explain. The following
quotes are taken from Dancing in the Rain edited
by Annabel Stehli. The first quote is from a six
year old who said 'The motorcycles are gone from
my head, and I can still hear people blink but
I can tune it out.'
Second is Charlie who, a month after AIT, said,
'when I laugh it doesn't bother me anymore.' To
repeat his mother's question 'Can you imagine
your ears hurting when you laughed?'
Third is Sharisa who has undergone Auditory Training
twice and is therefore well qualified to comment
upon the results. As she says '. . . . AIT has
enabled me to sleep better, be calmer while I'm
awake, and understand what I hear more quickly
and clearly. I can handle noises which had previously
caused me to withdraw or panic. These included
applause, sirens, dogs barking, vacuum-cleaners,
dishwashers, certain voices, the sound of fluorescent
lights, or piano music, computers, and sound of
the ocean. I believe it also reduced sensitivities
in sight, smell, taste, and tactile sensations.
I'm much, much happier and less inclined to anger.
(Stehli 1995, pp.86,100.)
Assessment and Treatment of Visual Perceptual
The recognition of this type of visual perceptual
problem amongst some people with autism and Asperger's
syndrome is an exciting development and the preliminary
results offer the hope that some of the most devastating
consequences of these can at least, be overcome.
Once again the checklist below should give some
indication as to whether or not treatment would
Indications of severe visual problems (which are
often particularly noticeable in the young).
Eyes are watery under bright light Suffers from
Looks at things with short quick glances Looks
Squints periodically Has bouts of blinking
Uses peripheral vision Finds eye contact difficult
Seems startled when approached Is slow to recognize
people at a distance
Does not seem 'in touch' with own body Misinterprets
Has dilated or narrowed pupils Opens eyes wide/stares
Attracted to light sources; stares at the sun
Rubs, pokes or hits eyes
Shields one eye with hand
Enjoys doing intricate work i.e. tapestry etc.
Looks at feet when walking
Afraid of/has difficulty with heights i.e. goes
downstairs one step at a time, has problems using
escalators etc. May stumble/fall when stepping
from one surface to another.
Doesn't appear to look where going Bumps into
Enjoys OR avoids:
being in the dark bright sunshine/lights
going through tunnels going through an avenue
Is fascinated with OR dislikes:-
shadows, reflections certain colours, stripes/patterns
Is very adept/has difficulty:-
picking things up catching a ball
putting a peg/object in a slot/hole (especially
if the hole is black)
Has difficulty colouring within lines
Creates extremely intricate designs
has problems when copying (better with large print)
uses large letters; runs words together
stops frequently/becomes tired quickly shuts or
misreads or combines words repeats words/lines
Has difficulty in distinguishing letters/words
on a blackboard/whiteboard or on a page
Currently only a few organizations are able to
carry out relevant tests and offer tinted lenses.
One is the Irlen Institute. While those able to
respond accurately are easy to assess for tints
the Irlen Institute, like myself, are also working
on testing people who are unable to co-operate;
which is obviously more difficult and time consuming.
Treatment for such visual perceptual problems
is now also available from the Institute of Optometry
in London (using a machine called a Colorimeter)
although this is more suitable for people who
can communicate accurately.
The benefits of tinted lenses.
Results are obviously dependent on the initial
problems but those treated suggest they include:
· better eye tracking: better depth perception.
· less confusion, improved behaviour.
· increased confidence, sociability and
· improvements in the ability to listen,
concentrate and learn.
· better memory and understanding.
· reduced hyperactivity
· increased ability to hold thoughts and
NB The wrong lenses will, at best, have no effect
and, at worst, could cause physical problems
(headaches/migraine) or even behavioural problems.
While the importance of factors such as diet are
increasingly acknowledged the significance of
the sensory problems is often overlooked. Surely
it is time to listen to the accounts of the people
who live with such problems every day. To take
them seriously. Some do have sensory problems
which cause great stress and distress. Detailed
investigation is needed to accurately gauge the
number of children and adults who are affected
by such sensory problems and enable any necessary
treatment to be given.
· Bérard, G. (1993) Hearing Equals
Behaviour. Keats Publishing.
· Gerland, G. and Tate, J. (trans) (1997)
A Real Person life on the outside. London Souvenir
· Gillingham, G. (1991) Autism: Disability
or Superability. Sunderland: Collected papers:
THERAPEUTIC APPROACHES TO AUTISM: RESEARCH AND
· Irlen, H. (1991) Reading by the Colors.
New York: Avery Publishing Group.
· Jordan, I. (1998) Visual Dyslexia. Desktop
· Stehli, A. (1990) The Sound of a Miracle.
· Stehli, A. (ed) (1995) Dancing in the
Rain. USA: The Georgiana Organization Inc.
· Volkmar, F. and Cohen, D.J. (1985)The
Experience of Infantile Autism: A First Person
Account by Tony W. (1985) Journal of Autism and
Developmental Disorders. 15,1,45-54.
· Waterhouse, S. (1999) A Positive Approach
to Autism. London: Jessica Kingsley Publishers.
· White, B.B. and M.S. (1987) Autism from
the Inside. Medical Hypotheses 24.
· Wilkins, A. (1995) Visual Stress. Oxford
· Williams, D. (1998) Like Color to the
Blind. London: Jessica Kingsley Publishers.
Stella Waterhouse is the author of A Positive
Approach To Autism 2000 Jessica Kingsley Publishers:London.
She also offer Auditory Training to people with
autism, Asperger's syndrome and related disorders.