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Noise and autism spectrum disorder in children: An exploratory survey
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Research in Developmental Disabilities
Noise and autism spectrum disorder in children: An exploratory survey Shireen M. Kanakri a,∗ , Mardelle Shepley b , James W. Varni c , Louis G. Tassinary d a Department of Family and Consumer Science, College of Applied Technology, Ball State University, Applied Technology Building 206, Muncie, IN, 47306, United States b Department of Design and Environmental Analysis, College of Human Ecology, Cornell University, 3429 Martha Van Rensselaer Hall, Ithaca, NY, 14853, United States c Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, 3137 TAMU, Texas A&M University, College Station, TX, 77843, United States d Department of Visualization, College of Architecture, Langford Center, 3137 TAMU C108, Texas A&M University, College Station, TX, 77840, United States
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Article history: Received 28 June 2016 Received in revised form 8 February 2017 Accepted 8 February 2017 Available online xxx Number of reviews completed is 2 Keywords: Autism ASD Acoustics Noise Classroom Built environment
a b s t r a c t Background: With more students being educated in schools for Autism Spectrum Disorder (ASD) than ever before, architects and interior designers need to consider the environmental features that may be modified to enhance the academic and social success of autistic students in school. Aim: This study explored existing empirical research on the impact of noise on children with ASD and provides recommendations regarding design features that can contribute to noise reduction. Methods and procedures: A survey, which addressed the impact of architectural design elements on autism-related behavior, was developed for teachers of children with ASD and distributed to three schools. Outcomes and results: Most teachers found noise control to be an important issue for students with autism and many observed children using ear defenders. In terms of managing issues related to noise, most teachers agreed that thick or soundproof walls and carpet in the classroom were the most important issues for children with ASD. Conclusions: Suggested future research should address architectural considerations for building an acoustically friendly environment for children with autism, identifying patterns of problematic behaviors in response to acoustical features of the built environment of the classroom setting, and ways to manage maladaptive behaviors in acoustically unfriendly environments. © 2017 Elsevier Ltd. All rights reserved.
What this paper adds This paper investigates how educators believe the acoustical environment can be modified to influence behavior of students with autism. Empirical evidence on how students with autism respond sensitively to lighting, sound, acoustics,
∗ Corresponding author. E-mail address: [email protected] (S.M. Kanakri). http://dx.doi.org/10.1016/j.ridd.2017.02.004 0891-4222/© 2017 Elsevier Ltd. All rights reserved.
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tactile sensations, scents, and other environmental factors is highlighted, in addition to the relationship between sound and unwanted behaviors from caregivers’ perspectives. The study demonstrates that noise pollution may be associated with children with ASD engaging in intrusive behaviors, such as covering their ears, as an attempt to regulate sound. Teachers who work with these children agreed that noise control is an important issue concerning the instruction of children with autism, which is aligned with past research. While teachers believed that the use wooden tables, chairs, and panels may be of benefit, most were ambivalent regarding thick or soundproof walls and carpet as methods of managing noise in the classroom. This highlights a need to provide educators with better information about noise pollution in the classroom, specifically the relationship between acoustic modifications and noise pollution. While prior research suggests that children with ASD engage in intrusive behaviors to regulate noise that negatively impacts health, there is limited empirical research on specific design modifications to help manage noise in a classroom setting. Recommendations based on the current study include further research on the impact of carpet, soundproofing for walls and ceilings, and wood tables and chairs, in addition to analyzing patterns of sensory response and problematic behaviors in children with ASD at school. 1. Introduction Noise may be defined as “the unpleasant sounds which distract the human being physically and physiologically and cause environmental pollution by destroying environmental properties” (Melnick, 1979; p. 721). Elevated levels of noise in a person’s environment have a significant negative impact on their health and result in both physiological and psychological outcomes (Atmaca, Peker, & Altin, 2005). A variety of physiological effects resulting from excess noise can interfere with task performance such as startle response, freezing, muscle tension, and an increased risk of aggressive behavior (Suter, 1989). In addition, noise can prompt increased blood pressure; accelerated heartbeat, trigger muscle reflexes, and sleep disturbances. In extreme cases, prolonged exposure to loud noise at greater than 85 dB can result in hearing loss. Psychological effects are often more prevalent than physiological effects, and can be exhibited in several ways including irritation, anxiety, anger, restlessness, and trouble perceiving and concentrating (Atmaca et al., 2005). The relationship between stress and elevated levels of noise can thus be significant. Halpern (1995) defines stress as, “that which imposes demands for adjustment upon an individual” (p. 28). Stressors in the environment may be sources of disturbance such as heat, chemical pollutants, and noise. These stressors can trigger a physiological reaction, which causes the sympathetic nervous system to exhibit a fight or flight response. Noise is negatively appraised when it is an unwanted or bothersome sound; however the appraisal of a sound as noise is subjective, and dependent on the internal state of the individual. Different individuals may exhibit unique responses to the same auditory stimuli. For example, elderly individuals often vocalize complaints about noise despite in general possessing objectively poorer hearing. This suggests that the sensitivity of a person’s hearing does not solely predict the subjective appraisal of sound as noise. Halpern (1995) hypothesized that if a sound is appraised as noise, it then induces annoyance and can thus cause an individual to experience stress. Findings on the extent to which noise appraisal is dependent on age vary (Van Kamp & Davies, 2013). For example, previous literature has shown that the exposure–annoyance curve of schoolchildren (aged 9–11 years) for aircraft noise, overall, has the same pattern as in adults. However, in the case of German children aged between 8 and 14 years, children were annoyed by road traffic noise at home less frequently than adults (Van Kamp and Davies, 2013). Thus, noise may be found to increase physiological and psychological distress, but individual experiences and perceptions of noise vary. 1.1. Noise across various environments According to Van Kamp and Davies (2013), “an area or place is defined as noise sensitive if noise interferes with the normal activities associated with the area’s use” (p. 153). Noise sensitive environments may be residential, educational, and recreational areas. Research regarding acoustic layouts of classrooms has shown that one major source of noise within the classroom is noise that occurs from nearby classrooms. This type of noise reduces speech intelligibility and privacy. Noise also, increases distractions, which can decrease attention (Shield, Greenland, & Dockrell, 2010). Crandell and Smaldino (2000) suggested four main acoustical variables interfere with perception in classrooms: reverberation time of the room, level of background noise, relationship between the level of the teacher’s voice and the level of the background noise, and the distance between the teacher and the child. Background noise played a large role within this framework, and included noises generated externally of the building, noises generated internally of the building, and noises generated from within the classroom. One significant contributor to the level of background noise within classrooms that was often noted was heating, ventilating, and air-conditioning systems (Woolner & Hall, 2010). Ljung et al. (2009)Ljung, Sörqvist, and Hygee (2009) concluded that road traffic noise heard from within classrooms impaired reading speed and basic mathematics, but had no significant effect on reading comprehension or on mathematical reasoning. Other research conducted in France with 10-year-old children found that noise exposure while at school was significantly associated with measures of fatigue, headaches, and higher cortisol levels, all indicators of the children’s stress reactions (Van Kamp and Davies, 2013). Shield and Dockrell (2008) investigated the effects of inside and outside noise Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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exposure in an educational setting with standard test scores for literacy, mathematics, and science in children aged 7–11 years, concluding that there was a negative association between noise and performance across subjects. Finally, the American Speech-Language-Hearing Association provides several recommendations for creating a good listening environment in the classroom (American Speech-Language-Hearing Association, 2016a,b). These recommendations included the use of carpet or rugs, hanging soft materials on the walls to interfere with sound, avoiding open floor plans, and placing latex-free soft tips on the bottoms of chairs and tables. 1.2. Noise and special populations Currently, the International Code Council’s A117.1 Accessible and Usable Buildings and Facilities Standards is responsible for regulating accessibility design features for schools. Noise and reverberation times have been largely ignored (American Speech-Language-Hearing Association, 2016a,b). The American Speech-Language Hearing Association is working with the American National Standards Institute and Armstrong Industries to develop new classroom acoustics building codes. These new codes will identify acceptable reverberation times for classrooms of various sizes, both occupied and unoccupied. Once these codes are adopted by the states, all new schools will be required to comply with these standards, which are expected to be published in 2016 (American Speech-Language-Hearing Association, 2016a,b). The World Health Organization (WHO) published guidelines to address ways to manage the effects of environmental noise of health, and concluded that future noise research will need to largely focus on vulnerable groups in which exposure to noise may have differential effects (WHO, 2016). Van Kamp and Davies (2013) suggest that noise-sensitivity effects may be studied as a generic vulnerability effect: as a group’s vulnerability to the effects of noise increase, the negatives effects and outcomes related to noise also increase. Thus, past findings of the adverse effects of noise with normal school-aged children are expected to be present at an increased level in a vulnerable population, such as children with Autism Spectrum Disorders (ASD). ASD are one example of a vulnerable group for whom the literature surrounding the impact of noise is sparse. This is an issue, given that in 2010 it was estimated that 1 in 68 eight-year-old children were currently diagnosed with ASD (Centers for Disease Control and Prevention, 2014). ASD is a neurodevelopmental condition that consists of deficits in social communication and interaction, as well as restrictive or repetitive patterns of behavior and interest, including hyperreactivity or increased interest in sensory stimuli (Lovaas, Varni, Koegel, & Lorsch, 1977). Individuals with ASD may exhibit extreme or ritualized responses to sensory input, including a fascination with or an aversion to certain sounds, sights, tastes, textures, or smells (American Psychiatric Association, 2013). Based on sensory experiments investigating auditory sensitivity in children with ASD, researchers now argue that the cause of auditory sensitivity reflects deficits in the appraisal of noise and corresponding emotional-behavioral dysregulation, rather than physiological deficits in auditory processing as was previously assumed (Stiegler & Davis, 2010). 1.3. Noise and autism Children with ASD are observed to use self-treatment strategies, automatic fear responses, or emotional regulatory strategies in response to their environment. This includes behaviors such as covering ears, crying, fleeing the area, humming, trembling, hyperventilating, and even self-injury (Stiegler & Davis, 2010). In a case study of a five-year old boy with ASD, Tang, Kennedy, Koppekin, and Caruso (2002) found ear covering was positively correlated with another child screaming. Bogdashina (2003) also reported that although others in the room may not be disturbed by the sound at all, children who were hypersensitive to noise often covered their ears because the noise was painful. Chang et al. (2012) found that children with ASD had high levels of sympathetic reactivity to sound, which the authors suggested was the origin of the observable behaviors children with ASD demonstrated. Similarly, observed behaviors in adults with ASD were potentially influenced by the individual’s auditory processing abilities (Kargas, López, Reddy, & Morris, 2015). Some research has suggested that these behaviors may be adaptive in nature, by increasing or decreasing sensory stimulation. For those with ASD who have hypo-sensitive hearing, behaviors like tapping or making noise may signal that the individual is enacting these behaviors to increase sensory stimulation. For those with ASD who have hypersensitive hearing, sounds may be perceived as loud and the individual may cover their ears to decrease sensory stimulation (Kargas et al., 2015). Alternatively, other research has suggested that children with ASD engage in behaviors that do not have a concluded function (Lovaas et al., 1977), such as flapping their hands in front of their eyes (Rogers & Pennington, 1991). Issues for individuals with ASD related to over-responsivity (aversion to sensory input) have been reported to contribute to disturbances in life activities and communication (Ben-Sasson, Soto, Martinez-Pedraza, & Carter, 2013). Thus, preoccupations related to sensory stimulation seeking or distractibility may contribute to difficulties with maintaining attention and learning (Tomcheck, Huebner & Dunn, 2014), and may contribute to deficits in observation learning in the school environment (Varni, Lovaas, Koegel, & Everett, 1979). Between 2004 and 2011, the number of children receiving special education services related to ASD in U.S. schools increased dramatically, with an estimated 417,000 students receiving these services by 2011 (National Center for Education Statistics, 2013). Shield et al. (2010) noted that there has been much research done on the impact of noise within a variety of classroom settings with typically developing children. Persson, Kristiansen, Lund, Shibuya, and Nielson (2013) compared Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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teacher perceptions of the social climate in classrooms with long and short reverberation times with a questionnaire. Results indicated classrooms with long reverberation times had a social climate perceived as more competitive, conflict laden, and less relaxed and comfortable. Connolly, Dockrell, Shield, Conetta, and Cox (2013) also used an online questionnaire to survey secondary students’ opinions of the acoustic environment of their school, and found that four factors were related to their impressions: ease of hearing, sensitivity to noise, the consequences of noise in the classroom, and annoyance to intermittent noise. Students with additional learning needs reported being more affected by a poor acoustical environment compared to non-hearing impaired students. Despite this, there have been few studies conducted with groups which may be vulnerable to noise. Findings from studies comparing typically developing children to vulnerable groups of children have suggested there is variability in the way noise affects these groups. For example, children diagnosed with ASD are often hypersensitive to noise, and thus can become more distracted by noise that other groups of children (Shield et al., 2010). Given that children diagnosed with ASD are often noise-sensitive, excessive noise inside and outside a classroom may lead the individual to become distracted, distressed, and inattentive, therefore impacting the student’s ability to learn (Tomcheck et al., 2014). There is a need for further research on the impact of noise across vulnerable groups, so that future work may create prevention and intervention strategies for reducing or eliminating noise.
1.4. Teachers’ perceptions Ashburner, Ziviani, & Rodger (2010) compared academic performance and emotional and behavioral regulation of students with ASD to typically developing students based on teachers’ perceptions. Students with ASD tended to feel overwhelmed by sensory stimuli in the classroom and had difficulty regulating their arousal level and appraising sensory input (Orekhova & Stroganova, 2014). This can cause students with ASD to experience attention and concentration difficulties, which can result in failure to re-orient attention to important cues during classroom activities (Ashburner et al., 2010; Orekhova & Stroganova, 2014). Hypersensitivity to sound may then lead to inattention during cognitive tasks, which contributes to academic underachievement (Ashburner, Ziviani, & Rogers, 2008). Emotional health in a school setting is also an area of concern for students with ASD. Compared to typically developing students, teachers have reported that students with ASD were more prone to depression, anxiety, sadness, low self-esteem, and loneliness, as well as difficulty with cooperation, assertion, and self-control, which can manifest in oppositional and aggressive behaviors (Kim, Szatmari, Bryson, Streiner, & Wilson, 2000). Researchers have suggested that this may be related to fears of certain sounds (phonophobia) and maladaptive learned emotional responses to these sounds (misophonia) (Stiegler & Davis, 2010). Children with ASD also experience increased irritability, which causes them to be prone to distress and anxiety (Ashburner et al., 2008), and which may adversely impact their health-related quality of life (Varni et al., 2012). Stiegler & Davis (2010) posited that interventions such as headphones or ear coverings are likely not appropriate solutions and may in fact increase the auditory sensitivity of individuals with ASD.
1.5. Increased sensitivity A potential explanation for this increased sensitivity to sights and sounds may be that children with ASD have increased perceptual capacity, or reduced inattentional blindness. Inattentional blindness can be defined as “failing to notice a conspicuous event” (Swettenham et al., 2014, p. 5). For example, Simons and Chabris (1999) had undergraduate students perform a difficult task that required a lot of focus, while a woman in a gorilla suit walked across the screen for five seconds. Nearly half of participants never noticed this conspicuous, unexpected event. This gorilla suit phenomenon is an example of inattentional blindness. Tillman, Olguin, Tuomainen, and Swettenham (2015) presented a similar unexpected stimulus to both traditionally developing children and children with ASD while they completed tasks that required different levels of attention. Results indicated that traditionally developing children were aware of the stimulus when the task was a light load, but unaware when the task load was heavy and required more focus and attention. However, children with ASD were aware of the stimulus, regardless of the task load. Swettenham et al. (2014) also garnered the same results, suggesting that the reduced inattentional blindness rates are due to increased perceptual load. In the past, interventions have been developed to manage problems stemming from issues related to sensory processing for students with ASD in the classroom (Case-Smith, Weaver, & Fristad, 2015; Banda, Griffin-Shirley, Okungu, Ogot, & Meeks, 2014), which suggested that such issues are of high concern to educators. Many of these interventions addressed individual coping rather than environmental solutions. Kinnealey et al. (2012) assessed whether installing sound-absorbing walls and halogen lights would increase attention of students with either ASD or Dyspraxia. Results showed that students’ attention and engagement increased, classroom performance improved, and levels of self-reported comfort and mood improved (Kinnealey et al., 2012). Thus, careful examination of environmental design is needed to build the knowledge base for environmental solutions to reducing auditory discomfort among individuals with ASD.
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1.6. Hypotheses An understanding of the impact of noise pollution for individuals with autism might lead to increased interest in methods of adapting the sound environment. In the current study, we hypothesized that teacher’ reports of observing behavior changes in children with autism in response to noise would be positively associated with higher ratings on the importance of managing noise levels via interior design modifications. We hypothesized that a similar positive association would be found across all interior design elements; reports of observation of behavior change would therefore be positively associated with thick or sound proof walls, carpet, use of wood chairs/tables, and use of wood panels. For the purposes of this study, observed behavior change was operationally defined as the use of ear defenders, and so may be termed ‘intrusive.’
2. Materials and methods 2.1. Participants Ninety-five teachers from three schools for children with moderate to high functioning ASD in Houston, Texas, were approached to participate in this study. The schools used as research sites were coded as: School 1, School 2, and School 3. Twenty-six out of 30 teachers at School 1 responded (87%), 25 out of 40 teachers at School 2 responded (65%), and 24 out of 25 teachers at School 3 responded (96%). In total 74 teachers completed surveys and the overall response rate for instructors across the three schools was 79%. Specific grade levels taught were preschool (17%), pre-kindergarten (3%), kindergarten (7%), lower elementary (10%), upper elementary (6%), middle school (17%), and high school (2%), with 38% of teachers teaching multiple grade levels. The most common types of classrooms reported by teachers were general education (48%), special education (8%), and specific subject or service classes (56%). Teachers reported spending an average of 30.28 h with their students each week (SD = 8.41). Most teachers reported having between one and ten students in their class. Teachers reported working with children with autism an average of 106.48 (SD = 84.72) months.
2.2. Recruitment Permission forms were sent to the schools to be signed and returned prior to participation. Administration of the teachers’ surveys took place from May 2011 to September 2011. This study was approved by the review boards for the participating schools.
2.3. Site selection To find suitable study settings and participants, the administrator at the Autism Center of the Texas Children’s Hospital was contacted in Houston, Texas, in May 2010. After two meetings with administrators, the researcher made several phone calls to the schools the Autism Center recommended. Four of the ten schools responded and are coded as: School 1, School 2, School 3, and School 4. The researcher chose the first three for this study. School 4 was eliminated as an option due to the lack of an appropriately structured interior design for the survey. The school was based on an unstructured, open plan with partitions separating the classes, which was not conducive to the study. School 1 had classrooms with no carpeting on the floor. Furniture in the classrooms consisted of plastic chairs with metal legs, and wooden desks with metal legs. School 2 had classrooms with carpet. Like School 1, furniture consisted of plastic chairs with metal legs, and wooden desks with metal legs. Both schools had an HVAC system that would turn off and on every ten minutes. School 3 had classrooms with no carpeting on the floor. Furniture in the classrooms consisted of plastic chairs with metal legs and wooden desk with metal legs.
2.4. Materials A survey, which addressed the impact of architectural design elements on autism-related behavior, was developed for the teachers of children with ASD. The purpose of this survey was to determine if the instructors believed there was a connection between disruptive behaviors and noise levels, and if they perceived elements of the environment as important to influencing noise levels. The questions for this survey were formulated based on input from multiple sources including interviews with parents, interviews with teachers, and a literature review. The most important source was the literature review and particularly the literature that focused on the stories and daily activities of people with autism such as Finding You Finding Me by Phoebe Caldwell (2006) and Born on a Blue Day by Daniel Tammet (2006). The teacher survey used a 5-point Likert Scale (1 = strongly disagree, 2 = somewhat disagree, 3 = neither agree nor disagree, 4 = somewhat agree, 5 = strongly agree) and open-ended questions. In addition to demographic questions about the teachers and their classrooms, a total of seven items addressed the following:
Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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Table 1 Teachers’ Ratings of Negative Impact of Classroom Noise (N = 74). Source of noise
Air conditioner Echoes Other children Other classrooms Traffic
Teacher Ratings (%) 1
2
3
4
5
47.3 48.6 2.7 0.0 0.0
50.0 45.9 5.4 0.0 0.0
2.7 1.4 23.0 13.5 59.5
0.0 2.7 13.5 59.5 24.3
0.0 1.4 55.4 27.0 16.2
Note. 1 = most negative, 5 = least negative.
1. In addition to air conditioner sounds, echoes, sounds from children in the classroom, sounds from other classrooms, and traffic noise, are there other acoustical environmental conditions that you feel negatively affect children with autism? 2. Please rank the following regarding how negatively they impact the children’s behavior: air conditioner, echoes, sounds from children in the classroom, sounds from other classrooms and traffic noise. 3. Are there aspects of the physical environment that you believe reduce the noise levels? 4. Describe the positive and negative acoustical qualities of the following types of rooms: classroom, common area, art room, computer lab and library, music and drama rooms, PE room. 5. As a teacher for children with autism, please evaluate the importance of carpet, wood panels, wood chairs, soundproofing, these aspects of the learning environment. 6. What types of behaviors do you see children doing that indicate that they are impacted by noise? 7. Do the children in the class ever attempt to reduce the noise by covering their ears or using ‘ear defenders? 2.5. Procedure Hardcopies of the surveys were received and distributed by administrators in each of the schools and teachers were initially given two weeks to respond. In School 1, the behavioral specialist presented the survey and explained the aim of the study to teachers at a faculty meeting to increase the teachers’ understanding regarding the importance of the study. To increase the response rate, the behavioral specialist sent subsequent reminder emails three times during June, July and August 2011. In School 2, the head of the school distributed the survey to teachers via mailboxes in the beginning of August 2011. The administrator sent reminders at the end of August and the beginning of September 2011, and no additional responses were received. In School 3, the survey was distributed by the principal/education specialist of the school via mailboxes in September 2011. Twenty-four of 25 teachers submitted responses by September 23, 2011. 3. Results 3.1. Environmental factors Nearly all (95.77%) of the teachers surveyed observed children covering their ears. Most teachers indicated they strongly agree that noise control is an important issue for children with autism (79%), followed by somewhat agree (14%), strongly disagree (4%), neither agree nor disagree (1%), and somewhat disagree (1%). A chi-square test of association was performed to test the several hypotheses, and a p-value of 0.01 rather than 0.05 was used to determine significance throughout to account for the number of statistical tests performed. The chi-square test of association was used to test the hypothesis that teachers who observed behavior change would be more likely to report noise control as an important issue for children with autism. Results indicated that no relationship was found between observance of behavior change and belief that noise control is an important issue X2 = (10, N = 74) = 12.691, p = 0.241. Teachers were asked to rank the following sources of noise in terms of how negatively they influence the behavior of children with autism, with 1 = most negative impact and 5 = least negative impact: air conditioner, echoes, sounds from children in the classroom, sounds from other classrooms, and traffic noise. Most teachers agreed that the air conditioner (M = 1.55, SD = 0.55) and echoes (M = 1.62, SD = 0.77) had the most negative impact, while sounds from other children (M = 4.14, SD = 1.11) and sounds from other classrooms (M = 4.14, SD = 0.63) had the least negative impact. Traffic noise was in the middle of the ranks (M = 3.57, SD = 0.76). To view individual percentages for each ranking, see Table 1. 3.2. Noise management Teachers were also asked to identify specific aspects of the physical environment they believed would reduce noise levels. Suggestions included carpeting (20.3%), wood furniture (17.7%), transitional spaces (12.2%), and thick or acoustical walls (4.3%). In addition, respondents were asked to identify the positive and negative acoustical aspects of various environments in their school, including the classroom, corridors, art room, computer room/library, music room, and physical education Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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Table 2 Percentage of Teachers Naming Positive Acoustical Aspects of School Spaces (N = 74). Positive aspect
Large space Transitional space Multi-zoning Has direction Wide Thick walls
School Space Classroom
Corridor
Art Room
Library
Music Room
PE Room
19.0 7.6 13.9 – – –
– – – 26.6 7.6 –
– – – – 6.3 –
– –
– – – – 1.4 46.9
– – – – – –
– – –
Note. Cells marked with – had no response or were not applicable.
Table 3 Percentage of Teachers Naming Negative Acoustical Aspects of School Spaces (N = 74). Negative aspect
No carpets Metal furniture Echoes Hard floors Noisy Long Wide Light walls High Ceiling
School Space Classroom
Corridor
Art Room
Library
Music Room
PE Room
15.2 9.5 13.5 13.5 – – – – –
– – 25.7 – 24.3 8.1 4.1 – –
– 16.2 2.7 27.0 10.8 – – 1.4 2.7
– 37.8 – 39.2 – – – – –
– – 29.7 – – – – – –
– – 14.9 10.8 – – – – –
Note. Cells marked with – had no response or were not applicable.
Table 4 Teacher Ratings of the Importance of Specific Design Modifications (N = 74). Design modification
Wood tables and chairs Carpet Thick walls Wood panels
Teacher Ratings (%) Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
1.4 34.7 45.2 2.7
31.5 34.7 42.4 16.4
52.1 22.2 5.5 75.3
12.3 4.2 4.1 4.1
2.7 4.2 2.7 1.4
room. In general, positive acoustical aspects of the various school spaces included having a transitional space, multi-zoning, large spaces, and thick walls (see Table 2). Negative acoustical aspects in the school settings included echoes, hard floors, metal furniture, light walls, high ceilings, and no carpet (see Table 3). A chi-square test of association was performed to test the hypothesis that teachers who observed behavior change (i.e., covering ears), would be more likely to view use of wood tables and chairs, thick walls, carpet, and wood panels in walls as important issues for children with autism in the classroom. Most teachers indicated they strongly agree that thick or sound proof walls are an important issue for children with autism (45.2%), followed by somewhat agree (42.4%). There was a significant relationship between teacher observation of behavior change and belief that thick walls is an important issue for children with autism, X2 = (10, N = 74) = 26.642, p = 0.003. The majority of teachers also indicated they strongly agree (34.7%) or somewhat agree (34.7%) having a carpet on the floor of the classroom is an important issue for children with autism. There was a significant relationship between observance of behavior change and belief that use of carpet is an important issue, X2 = (10, N = 74) = 30.450, p = 0.001. Most teachers also reported they neither agree nor disagree that using wood chairs and tables rather than steel chairs and tables is an important issue for children with autism (52.1%), followed by somewhat agree (31.5%). There was a significant relationship between teacher observation of behavior change and belief that wood tables and chairs is an important issue X2 = (10, N = 74) = 33.205, p = 0.001 Most teachers indicated that they neither agree nor disagree that having wood panels fixed over the wall is an important issue for children with autism (75.3%), followed by somewhat agree (16.4%). However, there was a significant relationship between observance of behavior change and belief that use of wood panels is an important issue, X2 = (10, N = 74) = 25.55, p = 0.004. To view all teacher responses for each of the design considerations, see Table 4.
Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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4. Discussion The main purpose of this survey was to receive input from teachers of children with ASD about the impact of noise pollution on disruptive behaviors. Overall, teachers were aware of changes in behavior in response to sensitivity to noise pollution. This aligns with past research which has shown that children with ASD often engage in behaviors that might intrude on learning to regulate the noise in their environment (Stiegler & Davis, 2010). For the specific behavior of covering ears, nearly all the teachers from the teacher survey reported observing children with ASD covering their ears and using ear defenders during times of loud noise in the classroom, consistent with prior findings (Bogdashina, 2003; Stiegler & Davis, 2011; Tang et al., 2002). Most teachers agreed that noise control is an important issue for children with autism, even if they did not observe children using ear defenders. Teacher surveys and prior research indicate noise control is an important issue for children with ASD. When children with ASD cannot manage the acoustics in the room due to noise, they may respond by covering their ears or using ear defenders. Environmental noise control via interior design modifications is an alternative solution to children resorting to covering their ears to manage the noise. Educators surveyed appeared to be aware of the relationship between acoustics and noise pollution for children with ASD. However, teachers who did not observe a behavior change in children due to noise were less likely to believe that specific design modifications, such as carpet in the classroom, are an important issue for children with autism. Overall, teachers were most ambivalent about the use of wood tables and chairs and wood panels fixed over the wall. This may demonstrate a need for better evidence for these modifications and the need for better information to be provided about noise pollution in classrooms used by children with ASD. To date, limited empirical research is available on modifying the classroom environment to address the educational and sensory needs of students with ASD (Martin, 2014). Currently, empirical reports suggest that behaviors related to noise include covering ears, academic underachievement, oppositional or aggressive behavior, self-stimulatory behavior, headbanging, and disruptive behavior (Special Needs Recourses, 2016). Anecdotal reports also suggest covering ears, shutting of hearing, and escaping the situation are common behaviors associated with noise sensitivity (Special Needs Recourses, 2016). The current study indicates teachers do observe that children with ASD cover their ears in response to sound sensitivity, and that this is disruptive to their learning. Sounds from the air conditioner and echoes in the classroom were reported to have the most negative impact on the students. Depression, anxiety, sadness, low self-esteem, loneliness, irritation, anger, restlessness, attention and concentration difficulties and hearing loss are common results of noise pollution (Goines & Hagler, 2007), and teacher surveys suggest academic underperformance can be caused by noise (Goines & Hagler, 2007). Given the general impacts of noise on the general population, and the increased sensory sensitivity that many with autism have, consideration of noise buffering in classrooms for children with ASD is an important topic. While the impacts of noise pollution for children with ASD are well documented, further evidence and education is needed on the design modifications that best address these issues. While the current study addresses educators’ perceptions of these concerns, it has some limitations. The current findings were reliant on self-report surveys. Other methodologies, such as laboratory controlled experiments, would be needed to provide information on how these modifications would benefit the educational experience of children with ASD. This report also relied on teacher sensitivity to these concerns. While the survey analyzed teachers’ perspectives, the findings do not directly reflect the experiences and perceptions of the children. Future research will be conducted to directly measure the relationship between children’s behaviors and noise levels, and will experimentally measure how frequency of behaviors can be manipulated through modifications that decrease noise levels in classroom environments. Specifically, areas of further research include investigating the impact of carpet, soundproofing for walls and ceilings and wooden tables and chairs, exploring ways to manage self-stimulatory behavior in an acoustically un-friendly environment, and analyzing patterns of sensory responding and/or problematic behaviors resulting from the acoustical features of the school built environment.
5. Conclusion Children with autism may demonstrate unique sensory profiles that influence the way they perceive and process different stimuli in the environment (Lane, Young, Baker, & Angley, 2010). However, few researchers have carefully examined the specific ways in which the acoustic environment of a facility may be modified to accommodate such unique sensory needs. Based on data from this study, the authors have proposed several areas of consideration for future research. By modifying the built environment in acoustically friendly ways, the treatment and education of children with autism may be greatly enhanced. There remains a significant knowledge gap in the current scientific literature as to how to build acoustically friendly environments for children with ASD. Specifically, the authors advocate for a controlled investigation of the behaviors of children with autism that might be specifically correlated with certain acoustical environments. Common behaviors reported by various caregivers related to noise in the environment have included fear responses such as covering ears, distractibility, and self-stimulatory behaviors (Bogdashina, 2003; Stiegler & Davis, 2011; Tang et al., 2002; Tomcheck et al., 2014), By understanding how behaviors are affected by environmental features such as carpet, walls, ceilings, furniture, and other stimuli, we can begin to create more therapeutic and academically compatible settings for children with autism in the school environment. Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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As more children with ASD are mainstreamed into typical school settings, these factors will need to be urgently addressed to facilitate the most nonrestrictive learning environment for these children. Educators must also be made aware of possible issues in the environments where children with ASD currently learn. Designing more acoustically friendly environments for children with ASD may be critical to enhancing their ability to learn in a classroom setting. Conflict of interest None. Funding source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Financial disclosure None. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C: American Psychiatric Association. American Speech-Language-Hearing Association. (2016). Tips for creating a good listening environment in the classroom. Retrieved from. www.asha.org American Speech-Language Hearing Association. (2016). Building code committee adopts classroom acoustics standard. Retrieved from. www.asha.org Ashburner, J. K., Ziviani, J., & Rogers, S. (2008). Sensory processing and classroom emotional: behavioral and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62, 564–573. Ashburner, J., Ziviani, J., & Rodger, S. (2010). Surviving in the mainstream: Capacity of children with autism spectrum disorders to perform academically and regulate their emotions and behavior at school. Research in Autism Spectrum Disorder, 4, 18–27. Atmaca, E., Peker, I., & Altin, A. (2005). Industrial noise and its effects on humans. Polish Journal of Environmental Studies, 14(6), 721–726. Banda, D. R., Griffin-Shirley, N., Okungu, P. A., Ogot, O. P., & Meeks, M. K. (2014). A review of intervention studies conducted with individuals with autism and sensory impairments. Journal of Visual Impairment & Blindness, 108(4), 299–309. Ben-Sasson, A., Soto, T. W., Martinez-Pedraza, F., & Carter, A. S. (2013). Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress. Journal of Child Psychology and Psychiatry, 54(8), 846–853. Bogdashina, O. (2003). Sensory perceptual issues in autism and Asperger syndrome: Different sensory experiences – different perceptual worlds. London: Jessica Kingsley. Caldwell, P. (2006). Finding you finding me: Using intensive interaction to get in touch with people whose severe learning disabilities are combined with autistic spectrum disorder. Jessica Kingsley Publishers. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19(2), 133–148. Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years. MMWR Publication No. 63(SS02). Chang, M. C., Parham, L. D., Blanche, E. I., Schell, A., Chou, C.-P., Dawson, M., et al. (2012). Autonomic and behavioral responses of children with autism to auditory stimuli. American Journal of Occupational Therapy, 66, 567–576. Connolly, D. M., Dockrell, J. E., Shield, B. M., Conetta, R., & Cox, T. J. (2013). Adolescents’ perceptions of their school’s acoustic environment: The development of an evidence based questionnaire. Noise and Health, 15(65), 269. Crandell, C. C., & Smaldino, J. J. (2000). Classroom acoustics for children with normal hearing and with hearing impairment. Language, Speech, and Hearing Services in Schools, 31, 363–370. Goines, L., & Hagler, L. (2007). Noise pollution: A modern plague. Southern Medical Journal, 100(3), 287–293. Halpern, D. (1995). More than bricks and mortar? Mental health and the built environment. London, England: Taylor & Francis. Kargas, N., López, B., Reddy, V., & Morris, P. (2015). The relationship between auditory processing and restricted, repetitive behaviors in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(3), 658–668. Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism: The International Journal of Research and Practice, 4(2), 117. Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M. L. (2012). Effect of classroom modification on attention and engagement of students with autism of dyspraxia. American Journal of Occupational Therapy, 66(5), 511–519. Lane, A. E., Young, R. L., Baker, A. E. Z., & Angley, M. T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism and Developmental Disorders, 40(1), 112–122. http://dx.doi.org/10.1007/s10803-009-0840-2 Ljung, R., Sörqvist, P., & Hygge, S. (2009). Effects of road traffic noise and irrelevant speech onhildren’s reading and mathematical performance. Noise & Health, 11(45), 194–198. Lovaas, O. I., Varni, J. W., Koegel, R. L., & Lorsch, N. (1977). Some observations on the non-extinguishability of children’s speech. Child Development, 48, 1121–1127. Martin, C. (2014). Exploring the impact of the design of the physical classroom environment on young children with autism spectrum disorder (ASD). Journal of Research in Special Education Needs, http://dx.doi.org/10.1111/1471-3802.12092 Melnick, W. (1979). Hearing loss from noise exposure. In C. M. Harris (Ed.), Handbook of noise control. New York: McGraw-Hill Book Company. National Center for Education Statistics. (2013). Digest of education statistics, 2012 (NCES publication No. 2014-015). Washington, D.C: US Government Printing Office. Orekhova, E. V., & Stroganova, T. A. (2014). Arousal and attention re-orienting in autism spectrum disorders: Evidence from auditory event-related potentials. Frontiers in Human Neuroscience, 8(34), 1–17. Persson, R., Kristiansen, J., Lund, S. P., Shibuya, H., & Nielsen, P. M. (2013). Classroom acoustics and hearing ability as determinants for perceived social climate and intentions to stay at work. Noise and Health, 15(67), 446. Shield, B., & Dockrell, J. (2008). The effects of environmental and classroom noise on the academic attainments of primary school children. Journal of the Acoustical Society of America, 123, 133–144. Shield, B., Greenland, E., & Dockrell, J. (2010). Noise in open plan classrooms in primary schools: A review. Noise & Health, 12(49), 225–234. Simons, D., & Chabris, C. (1999). Gorillas in our midst: sustained inattentional blindness for dynamic events. Perception, 28, 1059–1074. Stiegler, L., & Davis, R. (2010). Understanding sound sensitivity in individuals with Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 25(2), 67–75. Stiegler, L., & Davis, R. (2011). Managing sound sensitivity in individuals with ASD. Audiology Journal, 27, 299–312.
Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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10
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Suter, A. H. (1989). The effects of noise on performance Tech. Mem. 3-89. Aberdeen Proving Ground, MD: U.S. Army Human Engineering Lab. Swettenham, J., Remington, A., Murphy, P., Feuerstein, M., Grim, K., & Lavie, N. (2014). Seeing the unseen: Autism involves reduced susceptibility to inattentional blindness. Journal of Neuropsychology, 28(4), 563–570. http://dx.doi.org/10.1037/neu0000042 Tammet, D. (2006). Born on a blue day. New York: Free Press. Tang, J., Kennedy, C. H., Koppekin, A., & Caruso, M. (2002). Functional analysis of stereotypical ear covering in a child with autism. Journal of Applied Behavior Analysis, 35(1), 95–98. Tillman, J., Olguin, A., Tuomainen, J., & Swettenham, J. (2015). The effect of visual perceptual load on auditory awareness in Autism Spectrum Disorder. Journal of Developmental Disorders, 45(10), 329–3307. Tomcheck, S. D., Huebner, R. A., & Dunn, W. (2014). Patterns of sensory processing in children with an autism spectrum disorder. Research in Autism Spectrum Disorders, 8(9), 1214–1224. Van Kamp, I., & Davies, H. (2013). Noise and health in vulnerable groups: A review. Noise and Health, 15(64), 153–159. Varni, J. W., Lovaas, O. I., Koegel, R. L., & Everett, N. L. (1979). An analysis of observational learning in autistic and normal children. Journal of Abnormal Child Psychology, 7, 31–43. Varni, J. W., Handen, B. L., Corey-Lisle, P. K., Guo, Z., Manos, G., Ammerman, D. K., et al. (2012). Effect of Aripiprazole 2–15 mg/d on health-related quality of life in the treatment of irritability associated with Autistic Disorder in children: A post hoc analysis of two controlled trials. Clinical Therapeutics, 34, 980–992. World Health Organization. (2016). Training for health care providers: children and noise. Retrieved from. www.who.int/ceh Woolner, P., & Hall, E. (2010). Noise in schools: A holistic approach to the issue International. Journal of Environmental Research and Public Health, 7(8), 3255–3269. http://dx.doi.org/10.3390/ijerph7083255
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Research in Developmental Disabilities
Noise and autism spectrum disorder in children: An exploratory survey Shireen M. Kanakri a,∗ , Mardelle Shepley b , James W. Varni c , Louis G. Tassinary d a Department of Family and Consumer Science, College of Applied Technology, Ball State University, Applied Technology Building 206, Muncie, IN, 47306, United States b Department of Design and Environmental Analysis, College of Human Ecology, Cornell University, 3429 Martha Van Rensselaer Hall, Ithaca, NY, 14853, United States c Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, 3137 TAMU, Texas A&M University, College Station, TX, 77843, United States d Department of Visualization, College of Architecture, Langford Center, 3137 TAMU C108, Texas A&M University, College Station, TX, 77840, United States
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Article history: Received 28 June 2016 Received in revised form 8 February 2017 Accepted 8 February 2017 Available online xxx Number of reviews completed is 2 Keywords: Autism ASD Acoustics Noise Classroom Built environment
a b s t r a c t Background: With more students being educated in schools for Autism Spectrum Disorder (ASD) than ever before, architects and interior designers need to consider the environmental features that may be modified to enhance the academic and social success of autistic students in school. Aim: This study explored existing empirical research on the impact of noise on children with ASD and provides recommendations regarding design features that can contribute to noise reduction. Methods and procedures: A survey, which addressed the impact of architectural design elements on autism-related behavior, was developed for teachers of children with ASD and distributed to three schools. Outcomes and results: Most teachers found noise control to be an important issue for students with autism and many observed children using ear defenders. In terms of managing issues related to noise, most teachers agreed that thick or soundproof walls and carpet in the classroom were the most important issues for children with ASD. Conclusions: Suggested future research should address architectural considerations for building an acoustically friendly environment for children with autism, identifying patterns of problematic behaviors in response to acoustical features of the built environment of the classroom setting, and ways to manage maladaptive behaviors in acoustically unfriendly environments. © 2017 Elsevier Ltd. All rights reserved.
What this paper adds This paper investigates how educators believe the acoustical environment can be modified to influence behavior of students with autism. Empirical evidence on how students with autism respond sensitively to lighting, sound, acoustics,
∗ Corresponding author. E-mail address: [email protected] (S.M. Kanakri). http://dx.doi.org/10.1016/j.ridd.2017.02.004 0891-4222/© 2017 Elsevier Ltd. All rights reserved.
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tactile sensations, scents, and other environmental factors is highlighted, in addition to the relationship between sound and unwanted behaviors from caregivers’ perspectives. The study demonstrates that noise pollution may be associated with children with ASD engaging in intrusive behaviors, such as covering their ears, as an attempt to regulate sound. Teachers who work with these children agreed that noise control is an important issue concerning the instruction of children with autism, which is aligned with past research. While teachers believed that the use wooden tables, chairs, and panels may be of benefit, most were ambivalent regarding thick or soundproof walls and carpet as methods of managing noise in the classroom. This highlights a need to provide educators with better information about noise pollution in the classroom, specifically the relationship between acoustic modifications and noise pollution. While prior research suggests that children with ASD engage in intrusive behaviors to regulate noise that negatively impacts health, there is limited empirical research on specific design modifications to help manage noise in a classroom setting. Recommendations based on the current study include further research on the impact of carpet, soundproofing for walls and ceilings, and wood tables and chairs, in addition to analyzing patterns of sensory response and problematic behaviors in children with ASD at school. 1. Introduction Noise may be defined as “the unpleasant sounds which distract the human being physically and physiologically and cause environmental pollution by destroying environmental properties” (Melnick, 1979; p. 721). Elevated levels of noise in a person’s environment have a significant negative impact on their health and result in both physiological and psychological outcomes (Atmaca, Peker, & Altin, 2005). A variety of physiological effects resulting from excess noise can interfere with task performance such as startle response, freezing, muscle tension, and an increased risk of aggressive behavior (Suter, 1989). In addition, noise can prompt increased blood pressure; accelerated heartbeat, trigger muscle reflexes, and sleep disturbances. In extreme cases, prolonged exposure to loud noise at greater than 85 dB can result in hearing loss. Psychological effects are often more prevalent than physiological effects, and can be exhibited in several ways including irritation, anxiety, anger, restlessness, and trouble perceiving and concentrating (Atmaca et al., 2005). The relationship between stress and elevated levels of noise can thus be significant. Halpern (1995) defines stress as, “that which imposes demands for adjustment upon an individual” (p. 28). Stressors in the environment may be sources of disturbance such as heat, chemical pollutants, and noise. These stressors can trigger a physiological reaction, which causes the sympathetic nervous system to exhibit a fight or flight response. Noise is negatively appraised when it is an unwanted or bothersome sound; however the appraisal of a sound as noise is subjective, and dependent on the internal state of the individual. Different individuals may exhibit unique responses to the same auditory stimuli. For example, elderly individuals often vocalize complaints about noise despite in general possessing objectively poorer hearing. This suggests that the sensitivity of a person’s hearing does not solely predict the subjective appraisal of sound as noise. Halpern (1995) hypothesized that if a sound is appraised as noise, it then induces annoyance and can thus cause an individual to experience stress. Findings on the extent to which noise appraisal is dependent on age vary (Van Kamp & Davies, 2013). For example, previous literature has shown that the exposure–annoyance curve of schoolchildren (aged 9–11 years) for aircraft noise, overall, has the same pattern as in adults. However, in the case of German children aged between 8 and 14 years, children were annoyed by road traffic noise at home less frequently than adults (Van Kamp and Davies, 2013). Thus, noise may be found to increase physiological and psychological distress, but individual experiences and perceptions of noise vary. 1.1. Noise across various environments According to Van Kamp and Davies (2013), “an area or place is defined as noise sensitive if noise interferes with the normal activities associated with the area’s use” (p. 153). Noise sensitive environments may be residential, educational, and recreational areas. Research regarding acoustic layouts of classrooms has shown that one major source of noise within the classroom is noise that occurs from nearby classrooms. This type of noise reduces speech intelligibility and privacy. Noise also, increases distractions, which can decrease attention (Shield, Greenland, & Dockrell, 2010). Crandell and Smaldino (2000) suggested four main acoustical variables interfere with perception in classrooms: reverberation time of the room, level of background noise, relationship between the level of the teacher’s voice and the level of the background noise, and the distance between the teacher and the child. Background noise played a large role within this framework, and included noises generated externally of the building, noises generated internally of the building, and noises generated from within the classroom. One significant contributor to the level of background noise within classrooms that was often noted was heating, ventilating, and air-conditioning systems (Woolner & Hall, 2010). Ljung et al. (2009)Ljung, Sörqvist, and Hygee (2009) concluded that road traffic noise heard from within classrooms impaired reading speed and basic mathematics, but had no significant effect on reading comprehension or on mathematical reasoning. Other research conducted in France with 10-year-old children found that noise exposure while at school was significantly associated with measures of fatigue, headaches, and higher cortisol levels, all indicators of the children’s stress reactions (Van Kamp and Davies, 2013). Shield and Dockrell (2008) investigated the effects of inside and outside noise Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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exposure in an educational setting with standard test scores for literacy, mathematics, and science in children aged 7–11 years, concluding that there was a negative association between noise and performance across subjects. Finally, the American Speech-Language-Hearing Association provides several recommendations for creating a good listening environment in the classroom (American Speech-Language-Hearing Association, 2016a,b). These recommendations included the use of carpet or rugs, hanging soft materials on the walls to interfere with sound, avoiding open floor plans, and placing latex-free soft tips on the bottoms of chairs and tables. 1.2. Noise and special populations Currently, the International Code Council’s A117.1 Accessible and Usable Buildings and Facilities Standards is responsible for regulating accessibility design features for schools. Noise and reverberation times have been largely ignored (American Speech-Language-Hearing Association, 2016a,b). The American Speech-Language Hearing Association is working with the American National Standards Institute and Armstrong Industries to develop new classroom acoustics building codes. These new codes will identify acceptable reverberation times for classrooms of various sizes, both occupied and unoccupied. Once these codes are adopted by the states, all new schools will be required to comply with these standards, which are expected to be published in 2016 (American Speech-Language-Hearing Association, 2016a,b). The World Health Organization (WHO) published guidelines to address ways to manage the effects of environmental noise of health, and concluded that future noise research will need to largely focus on vulnerable groups in which exposure to noise may have differential effects (WHO, 2016). Van Kamp and Davies (2013) suggest that noise-sensitivity effects may be studied as a generic vulnerability effect: as a group’s vulnerability to the effects of noise increase, the negatives effects and outcomes related to noise also increase. Thus, past findings of the adverse effects of noise with normal school-aged children are expected to be present at an increased level in a vulnerable population, such as children with Autism Spectrum Disorders (ASD). ASD are one example of a vulnerable group for whom the literature surrounding the impact of noise is sparse. This is an issue, given that in 2010 it was estimated that 1 in 68 eight-year-old children were currently diagnosed with ASD (Centers for Disease Control and Prevention, 2014). ASD is a neurodevelopmental condition that consists of deficits in social communication and interaction, as well as restrictive or repetitive patterns of behavior and interest, including hyperreactivity or increased interest in sensory stimuli (Lovaas, Varni, Koegel, & Lorsch, 1977). Individuals with ASD may exhibit extreme or ritualized responses to sensory input, including a fascination with or an aversion to certain sounds, sights, tastes, textures, or smells (American Psychiatric Association, 2013). Based on sensory experiments investigating auditory sensitivity in children with ASD, researchers now argue that the cause of auditory sensitivity reflects deficits in the appraisal of noise and corresponding emotional-behavioral dysregulation, rather than physiological deficits in auditory processing as was previously assumed (Stiegler & Davis, 2010). 1.3. Noise and autism Children with ASD are observed to use self-treatment strategies, automatic fear responses, or emotional regulatory strategies in response to their environment. This includes behaviors such as covering ears, crying, fleeing the area, humming, trembling, hyperventilating, and even self-injury (Stiegler & Davis, 2010). In a case study of a five-year old boy with ASD, Tang, Kennedy, Koppekin, and Caruso (2002) found ear covering was positively correlated with another child screaming. Bogdashina (2003) also reported that although others in the room may not be disturbed by the sound at all, children who were hypersensitive to noise often covered their ears because the noise was painful. Chang et al. (2012) found that children with ASD had high levels of sympathetic reactivity to sound, which the authors suggested was the origin of the observable behaviors children with ASD demonstrated. Similarly, observed behaviors in adults with ASD were potentially influenced by the individual’s auditory processing abilities (Kargas, López, Reddy, & Morris, 2015). Some research has suggested that these behaviors may be adaptive in nature, by increasing or decreasing sensory stimulation. For those with ASD who have hypo-sensitive hearing, behaviors like tapping or making noise may signal that the individual is enacting these behaviors to increase sensory stimulation. For those with ASD who have hypersensitive hearing, sounds may be perceived as loud and the individual may cover their ears to decrease sensory stimulation (Kargas et al., 2015). Alternatively, other research has suggested that children with ASD engage in behaviors that do not have a concluded function (Lovaas et al., 1977), such as flapping their hands in front of their eyes (Rogers & Pennington, 1991). Issues for individuals with ASD related to over-responsivity (aversion to sensory input) have been reported to contribute to disturbances in life activities and communication (Ben-Sasson, Soto, Martinez-Pedraza, & Carter, 2013). Thus, preoccupations related to sensory stimulation seeking or distractibility may contribute to difficulties with maintaining attention and learning (Tomcheck, Huebner & Dunn, 2014), and may contribute to deficits in observation learning in the school environment (Varni, Lovaas, Koegel, & Everett, 1979). Between 2004 and 2011, the number of children receiving special education services related to ASD in U.S. schools increased dramatically, with an estimated 417,000 students receiving these services by 2011 (National Center for Education Statistics, 2013). Shield et al. (2010) noted that there has been much research done on the impact of noise within a variety of classroom settings with typically developing children. Persson, Kristiansen, Lund, Shibuya, and Nielson (2013) compared Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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teacher perceptions of the social climate in classrooms with long and short reverberation times with a questionnaire. Results indicated classrooms with long reverberation times had a social climate perceived as more competitive, conflict laden, and less relaxed and comfortable. Connolly, Dockrell, Shield, Conetta, and Cox (2013) also used an online questionnaire to survey secondary students’ opinions of the acoustic environment of their school, and found that four factors were related to their impressions: ease of hearing, sensitivity to noise, the consequences of noise in the classroom, and annoyance to intermittent noise. Students with additional learning needs reported being more affected by a poor acoustical environment compared to non-hearing impaired students. Despite this, there have been few studies conducted with groups which may be vulnerable to noise. Findings from studies comparing typically developing children to vulnerable groups of children have suggested there is variability in the way noise affects these groups. For example, children diagnosed with ASD are often hypersensitive to noise, and thus can become more distracted by noise that other groups of children (Shield et al., 2010). Given that children diagnosed with ASD are often noise-sensitive, excessive noise inside and outside a classroom may lead the individual to become distracted, distressed, and inattentive, therefore impacting the student’s ability to learn (Tomcheck et al., 2014). There is a need for further research on the impact of noise across vulnerable groups, so that future work may create prevention and intervention strategies for reducing or eliminating noise.
1.4. Teachers’ perceptions Ashburner, Ziviani, & Rodger (2010) compared academic performance and emotional and behavioral regulation of students with ASD to typically developing students based on teachers’ perceptions. Students with ASD tended to feel overwhelmed by sensory stimuli in the classroom and had difficulty regulating their arousal level and appraising sensory input (Orekhova & Stroganova, 2014). This can cause students with ASD to experience attention and concentration difficulties, which can result in failure to re-orient attention to important cues during classroom activities (Ashburner et al., 2010; Orekhova & Stroganova, 2014). Hypersensitivity to sound may then lead to inattention during cognitive tasks, which contributes to academic underachievement (Ashburner, Ziviani, & Rogers, 2008). Emotional health in a school setting is also an area of concern for students with ASD. Compared to typically developing students, teachers have reported that students with ASD were more prone to depression, anxiety, sadness, low self-esteem, and loneliness, as well as difficulty with cooperation, assertion, and self-control, which can manifest in oppositional and aggressive behaviors (Kim, Szatmari, Bryson, Streiner, & Wilson, 2000). Researchers have suggested that this may be related to fears of certain sounds (phonophobia) and maladaptive learned emotional responses to these sounds (misophonia) (Stiegler & Davis, 2010). Children with ASD also experience increased irritability, which causes them to be prone to distress and anxiety (Ashburner et al., 2008), and which may adversely impact their health-related quality of life (Varni et al., 2012). Stiegler & Davis (2010) posited that interventions such as headphones or ear coverings are likely not appropriate solutions and may in fact increase the auditory sensitivity of individuals with ASD.
1.5. Increased sensitivity A potential explanation for this increased sensitivity to sights and sounds may be that children with ASD have increased perceptual capacity, or reduced inattentional blindness. Inattentional blindness can be defined as “failing to notice a conspicuous event” (Swettenham et al., 2014, p. 5). For example, Simons and Chabris (1999) had undergraduate students perform a difficult task that required a lot of focus, while a woman in a gorilla suit walked across the screen for five seconds. Nearly half of participants never noticed this conspicuous, unexpected event. This gorilla suit phenomenon is an example of inattentional blindness. Tillman, Olguin, Tuomainen, and Swettenham (2015) presented a similar unexpected stimulus to both traditionally developing children and children with ASD while they completed tasks that required different levels of attention. Results indicated that traditionally developing children were aware of the stimulus when the task was a light load, but unaware when the task load was heavy and required more focus and attention. However, children with ASD were aware of the stimulus, regardless of the task load. Swettenham et al. (2014) also garnered the same results, suggesting that the reduced inattentional blindness rates are due to increased perceptual load. In the past, interventions have been developed to manage problems stemming from issues related to sensory processing for students with ASD in the classroom (Case-Smith, Weaver, & Fristad, 2015; Banda, Griffin-Shirley, Okungu, Ogot, & Meeks, 2014), which suggested that such issues are of high concern to educators. Many of these interventions addressed individual coping rather than environmental solutions. Kinnealey et al. (2012) assessed whether installing sound-absorbing walls and halogen lights would increase attention of students with either ASD or Dyspraxia. Results showed that students’ attention and engagement increased, classroom performance improved, and levels of self-reported comfort and mood improved (Kinnealey et al., 2012). Thus, careful examination of environmental design is needed to build the knowledge base for environmental solutions to reducing auditory discomfort among individuals with ASD.
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1.6. Hypotheses An understanding of the impact of noise pollution for individuals with autism might lead to increased interest in methods of adapting the sound environment. In the current study, we hypothesized that teacher’ reports of observing behavior changes in children with autism in response to noise would be positively associated with higher ratings on the importance of managing noise levels via interior design modifications. We hypothesized that a similar positive association would be found across all interior design elements; reports of observation of behavior change would therefore be positively associated with thick or sound proof walls, carpet, use of wood chairs/tables, and use of wood panels. For the purposes of this study, observed behavior change was operationally defined as the use of ear defenders, and so may be termed ‘intrusive.’
2. Materials and methods 2.1. Participants Ninety-five teachers from three schools for children with moderate to high functioning ASD in Houston, Texas, were approached to participate in this study. The schools used as research sites were coded as: School 1, School 2, and School 3. Twenty-six out of 30 teachers at School 1 responded (87%), 25 out of 40 teachers at School 2 responded (65%), and 24 out of 25 teachers at School 3 responded (96%). In total 74 teachers completed surveys and the overall response rate for instructors across the three schools was 79%. Specific grade levels taught were preschool (17%), pre-kindergarten (3%), kindergarten (7%), lower elementary (10%), upper elementary (6%), middle school (17%), and high school (2%), with 38% of teachers teaching multiple grade levels. The most common types of classrooms reported by teachers were general education (48%), special education (8%), and specific subject or service classes (56%). Teachers reported spending an average of 30.28 h with their students each week (SD = 8.41). Most teachers reported having between one and ten students in their class. Teachers reported working with children with autism an average of 106.48 (SD = 84.72) months.
2.2. Recruitment Permission forms were sent to the schools to be signed and returned prior to participation. Administration of the teachers’ surveys took place from May 2011 to September 2011. This study was approved by the review boards for the participating schools.
2.3. Site selection To find suitable study settings and participants, the administrator at the Autism Center of the Texas Children’s Hospital was contacted in Houston, Texas, in May 2010. After two meetings with administrators, the researcher made several phone calls to the schools the Autism Center recommended. Four of the ten schools responded and are coded as: School 1, School 2, School 3, and School 4. The researcher chose the first three for this study. School 4 was eliminated as an option due to the lack of an appropriately structured interior design for the survey. The school was based on an unstructured, open plan with partitions separating the classes, which was not conducive to the study. School 1 had classrooms with no carpeting on the floor. Furniture in the classrooms consisted of plastic chairs with metal legs, and wooden desks with metal legs. School 2 had classrooms with carpet. Like School 1, furniture consisted of plastic chairs with metal legs, and wooden desks with metal legs. Both schools had an HVAC system that would turn off and on every ten minutes. School 3 had classrooms with no carpeting on the floor. Furniture in the classrooms consisted of plastic chairs with metal legs and wooden desk with metal legs.
2.4. Materials A survey, which addressed the impact of architectural design elements on autism-related behavior, was developed for the teachers of children with ASD. The purpose of this survey was to determine if the instructors believed there was a connection between disruptive behaviors and noise levels, and if they perceived elements of the environment as important to influencing noise levels. The questions for this survey were formulated based on input from multiple sources including interviews with parents, interviews with teachers, and a literature review. The most important source was the literature review and particularly the literature that focused on the stories and daily activities of people with autism such as Finding You Finding Me by Phoebe Caldwell (2006) and Born on a Blue Day by Daniel Tammet (2006). The teacher survey used a 5-point Likert Scale (1 = strongly disagree, 2 = somewhat disagree, 3 = neither agree nor disagree, 4 = somewhat agree, 5 = strongly agree) and open-ended questions. In addition to demographic questions about the teachers and their classrooms, a total of seven items addressed the following:
Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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Table 1 Teachers’ Ratings of Negative Impact of Classroom Noise (N = 74). Source of noise
Air conditioner Echoes Other children Other classrooms Traffic
Teacher Ratings (%) 1
2
3
4
5
47.3 48.6 2.7 0.0 0.0
50.0 45.9 5.4 0.0 0.0
2.7 1.4 23.0 13.5 59.5
0.0 2.7 13.5 59.5 24.3
0.0 1.4 55.4 27.0 16.2
Note. 1 = most negative, 5 = least negative.
1. In addition to air conditioner sounds, echoes, sounds from children in the classroom, sounds from other classrooms, and traffic noise, are there other acoustical environmental conditions that you feel negatively affect children with autism? 2. Please rank the following regarding how negatively they impact the children’s behavior: air conditioner, echoes, sounds from children in the classroom, sounds from other classrooms and traffic noise. 3. Are there aspects of the physical environment that you believe reduce the noise levels? 4. Describe the positive and negative acoustical qualities of the following types of rooms: classroom, common area, art room, computer lab and library, music and drama rooms, PE room. 5. As a teacher for children with autism, please evaluate the importance of carpet, wood panels, wood chairs, soundproofing, these aspects of the learning environment. 6. What types of behaviors do you see children doing that indicate that they are impacted by noise? 7. Do the children in the class ever attempt to reduce the noise by covering their ears or using ‘ear defenders? 2.5. Procedure Hardcopies of the surveys were received and distributed by administrators in each of the schools and teachers were initially given two weeks to respond. In School 1, the behavioral specialist presented the survey and explained the aim of the study to teachers at a faculty meeting to increase the teachers’ understanding regarding the importance of the study. To increase the response rate, the behavioral specialist sent subsequent reminder emails three times during June, July and August 2011. In School 2, the head of the school distributed the survey to teachers via mailboxes in the beginning of August 2011. The administrator sent reminders at the end of August and the beginning of September 2011, and no additional responses were received. In School 3, the survey was distributed by the principal/education specialist of the school via mailboxes in September 2011. Twenty-four of 25 teachers submitted responses by September 23, 2011. 3. Results 3.1. Environmental factors Nearly all (95.77%) of the teachers surveyed observed children covering their ears. Most teachers indicated they strongly agree that noise control is an important issue for children with autism (79%), followed by somewhat agree (14%), strongly disagree (4%), neither agree nor disagree (1%), and somewhat disagree (1%). A chi-square test of association was performed to test the several hypotheses, and a p-value of 0.01 rather than 0.05 was used to determine significance throughout to account for the number of statistical tests performed. The chi-square test of association was used to test the hypothesis that teachers who observed behavior change would be more likely to report noise control as an important issue for children with autism. Results indicated that no relationship was found between observance of behavior change and belief that noise control is an important issue X2 = (10, N = 74) = 12.691, p = 0.241. Teachers were asked to rank the following sources of noise in terms of how negatively they influence the behavior of children with autism, with 1 = most negative impact and 5 = least negative impact: air conditioner, echoes, sounds from children in the classroom, sounds from other classrooms, and traffic noise. Most teachers agreed that the air conditioner (M = 1.55, SD = 0.55) and echoes (M = 1.62, SD = 0.77) had the most negative impact, while sounds from other children (M = 4.14, SD = 1.11) and sounds from other classrooms (M = 4.14, SD = 0.63) had the least negative impact. Traffic noise was in the middle of the ranks (M = 3.57, SD = 0.76). To view individual percentages for each ranking, see Table 1. 3.2. Noise management Teachers were also asked to identify specific aspects of the physical environment they believed would reduce noise levels. Suggestions included carpeting (20.3%), wood furniture (17.7%), transitional spaces (12.2%), and thick or acoustical walls (4.3%). In addition, respondents were asked to identify the positive and negative acoustical aspects of various environments in their school, including the classroom, corridors, art room, computer room/library, music room, and physical education Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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Table 2 Percentage of Teachers Naming Positive Acoustical Aspects of School Spaces (N = 74). Positive aspect
Large space Transitional space Multi-zoning Has direction Wide Thick walls
School Space Classroom
Corridor
Art Room
Library
Music Room
PE Room
19.0 7.6 13.9 – – –
– – – 26.6 7.6 –
– – – – 6.3 –
– –
– – – – 1.4 46.9
– – – – – –
– – –
Note. Cells marked with – had no response or were not applicable.
Table 3 Percentage of Teachers Naming Negative Acoustical Aspects of School Spaces (N = 74). Negative aspect
No carpets Metal furniture Echoes Hard floors Noisy Long Wide Light walls High Ceiling
School Space Classroom
Corridor
Art Room
Library
Music Room
PE Room
15.2 9.5 13.5 13.5 – – – – –
– – 25.7 – 24.3 8.1 4.1 – –
– 16.2 2.7 27.0 10.8 – – 1.4 2.7
– 37.8 – 39.2 – – – – –
– – 29.7 – – – – – –
– – 14.9 10.8 – – – – –
Note. Cells marked with – had no response or were not applicable.
Table 4 Teacher Ratings of the Importance of Specific Design Modifications (N = 74). Design modification
Wood tables and chairs Carpet Thick walls Wood panels
Teacher Ratings (%) Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
1.4 34.7 45.2 2.7
31.5 34.7 42.4 16.4
52.1 22.2 5.5 75.3
12.3 4.2 4.1 4.1
2.7 4.2 2.7 1.4
room. In general, positive acoustical aspects of the various school spaces included having a transitional space, multi-zoning, large spaces, and thick walls (see Table 2). Negative acoustical aspects in the school settings included echoes, hard floors, metal furniture, light walls, high ceilings, and no carpet (see Table 3). A chi-square test of association was performed to test the hypothesis that teachers who observed behavior change (i.e., covering ears), would be more likely to view use of wood tables and chairs, thick walls, carpet, and wood panels in walls as important issues for children with autism in the classroom. Most teachers indicated they strongly agree that thick or sound proof walls are an important issue for children with autism (45.2%), followed by somewhat agree (42.4%). There was a significant relationship between teacher observation of behavior change and belief that thick walls is an important issue for children with autism, X2 = (10, N = 74) = 26.642, p = 0.003. The majority of teachers also indicated they strongly agree (34.7%) or somewhat agree (34.7%) having a carpet on the floor of the classroom is an important issue for children with autism. There was a significant relationship between observance of behavior change and belief that use of carpet is an important issue, X2 = (10, N = 74) = 30.450, p = 0.001. Most teachers also reported they neither agree nor disagree that using wood chairs and tables rather than steel chairs and tables is an important issue for children with autism (52.1%), followed by somewhat agree (31.5%). There was a significant relationship between teacher observation of behavior change and belief that wood tables and chairs is an important issue X2 = (10, N = 74) = 33.205, p = 0.001 Most teachers indicated that they neither agree nor disagree that having wood panels fixed over the wall is an important issue for children with autism (75.3%), followed by somewhat agree (16.4%). However, there was a significant relationship between observance of behavior change and belief that use of wood panels is an important issue, X2 = (10, N = 74) = 25.55, p = 0.004. To view all teacher responses for each of the design considerations, see Table 4.
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4. Discussion The main purpose of this survey was to receive input from teachers of children with ASD about the impact of noise pollution on disruptive behaviors. Overall, teachers were aware of changes in behavior in response to sensitivity to noise pollution. This aligns with past research which has shown that children with ASD often engage in behaviors that might intrude on learning to regulate the noise in their environment (Stiegler & Davis, 2010). For the specific behavior of covering ears, nearly all the teachers from the teacher survey reported observing children with ASD covering their ears and using ear defenders during times of loud noise in the classroom, consistent with prior findings (Bogdashina, 2003; Stiegler & Davis, 2011; Tang et al., 2002). Most teachers agreed that noise control is an important issue for children with autism, even if they did not observe children using ear defenders. Teacher surveys and prior research indicate noise control is an important issue for children with ASD. When children with ASD cannot manage the acoustics in the room due to noise, they may respond by covering their ears or using ear defenders. Environmental noise control via interior design modifications is an alternative solution to children resorting to covering their ears to manage the noise. Educators surveyed appeared to be aware of the relationship between acoustics and noise pollution for children with ASD. However, teachers who did not observe a behavior change in children due to noise were less likely to believe that specific design modifications, such as carpet in the classroom, are an important issue for children with autism. Overall, teachers were most ambivalent about the use of wood tables and chairs and wood panels fixed over the wall. This may demonstrate a need for better evidence for these modifications and the need for better information to be provided about noise pollution in classrooms used by children with ASD. To date, limited empirical research is available on modifying the classroom environment to address the educational and sensory needs of students with ASD (Martin, 2014). Currently, empirical reports suggest that behaviors related to noise include covering ears, academic underachievement, oppositional or aggressive behavior, self-stimulatory behavior, headbanging, and disruptive behavior (Special Needs Recourses, 2016). Anecdotal reports also suggest covering ears, shutting of hearing, and escaping the situation are common behaviors associated with noise sensitivity (Special Needs Recourses, 2016). The current study indicates teachers do observe that children with ASD cover their ears in response to sound sensitivity, and that this is disruptive to their learning. Sounds from the air conditioner and echoes in the classroom were reported to have the most negative impact on the students. Depression, anxiety, sadness, low self-esteem, loneliness, irritation, anger, restlessness, attention and concentration difficulties and hearing loss are common results of noise pollution (Goines & Hagler, 2007), and teacher surveys suggest academic underperformance can be caused by noise (Goines & Hagler, 2007). Given the general impacts of noise on the general population, and the increased sensory sensitivity that many with autism have, consideration of noise buffering in classrooms for children with ASD is an important topic. While the impacts of noise pollution for children with ASD are well documented, further evidence and education is needed on the design modifications that best address these issues. While the current study addresses educators’ perceptions of these concerns, it has some limitations. The current findings were reliant on self-report surveys. Other methodologies, such as laboratory controlled experiments, would be needed to provide information on how these modifications would benefit the educational experience of children with ASD. This report also relied on teacher sensitivity to these concerns. While the survey analyzed teachers’ perspectives, the findings do not directly reflect the experiences and perceptions of the children. Future research will be conducted to directly measure the relationship between children’s behaviors and noise levels, and will experimentally measure how frequency of behaviors can be manipulated through modifications that decrease noise levels in classroom environments. Specifically, areas of further research include investigating the impact of carpet, soundproofing for walls and ceilings and wooden tables and chairs, exploring ways to manage self-stimulatory behavior in an acoustically un-friendly environment, and analyzing patterns of sensory responding and/or problematic behaviors resulting from the acoustical features of the school built environment.
5. Conclusion Children with autism may demonstrate unique sensory profiles that influence the way they perceive and process different stimuli in the environment (Lane, Young, Baker, & Angley, 2010). However, few researchers have carefully examined the specific ways in which the acoustic environment of a facility may be modified to accommodate such unique sensory needs. Based on data from this study, the authors have proposed several areas of consideration for future research. By modifying the built environment in acoustically friendly ways, the treatment and education of children with autism may be greatly enhanced. There remains a significant knowledge gap in the current scientific literature as to how to build acoustically friendly environments for children with ASD. Specifically, the authors advocate for a controlled investigation of the behaviors of children with autism that might be specifically correlated with certain acoustical environments. Common behaviors reported by various caregivers related to noise in the environment have included fear responses such as covering ears, distractibility, and self-stimulatory behaviors (Bogdashina, 2003; Stiegler & Davis, 2011; Tang et al., 2002; Tomcheck et al., 2014), By understanding how behaviors are affected by environmental features such as carpet, walls, ceilings, furniture, and other stimuli, we can begin to create more therapeutic and academically compatible settings for children with autism in the school environment. Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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As more children with ASD are mainstreamed into typical school settings, these factors will need to be urgently addressed to facilitate the most nonrestrictive learning environment for these children. Educators must also be made aware of possible issues in the environments where children with ASD currently learn. Designing more acoustically friendly environments for children with ASD may be critical to enhancing their ability to learn in a classroom setting. Conflict of interest None. Funding source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Financial disclosure None. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C: American Psychiatric Association. American Speech-Language-Hearing Association. (2016). Tips for creating a good listening environment in the classroom. Retrieved from. www.asha.org American Speech-Language Hearing Association. (2016). Building code committee adopts classroom acoustics standard. Retrieved from. www.asha.org Ashburner, J. K., Ziviani, J., & Rogers, S. (2008). Sensory processing and classroom emotional: behavioral and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62, 564–573. Ashburner, J., Ziviani, J., & Rodger, S. (2010). Surviving in the mainstream: Capacity of children with autism spectrum disorders to perform academically and regulate their emotions and behavior at school. Research in Autism Spectrum Disorder, 4, 18–27. Atmaca, E., Peker, I., & Altin, A. (2005). Industrial noise and its effects on humans. Polish Journal of Environmental Studies, 14(6), 721–726. Banda, D. R., Griffin-Shirley, N., Okungu, P. A., Ogot, O. P., & Meeks, M. K. (2014). A review of intervention studies conducted with individuals with autism and sensory impairments. Journal of Visual Impairment & Blindness, 108(4), 299–309. Ben-Sasson, A., Soto, T. W., Martinez-Pedraza, F., & Carter, A. S. (2013). Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress. Journal of Child Psychology and Psychiatry, 54(8), 846–853. Bogdashina, O. (2003). Sensory perceptual issues in autism and Asperger syndrome: Different sensory experiences – different perceptual worlds. London: Jessica Kingsley. Caldwell, P. (2006). Finding you finding me: Using intensive interaction to get in touch with people whose severe learning disabilities are combined with autistic spectrum disorder. Jessica Kingsley Publishers. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19(2), 133–148. Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years. MMWR Publication No. 63(SS02). Chang, M. C., Parham, L. D., Blanche, E. I., Schell, A., Chou, C.-P., Dawson, M., et al. (2012). Autonomic and behavioral responses of children with autism to auditory stimuli. American Journal of Occupational Therapy, 66, 567–576. Connolly, D. M., Dockrell, J. E., Shield, B. M., Conetta, R., & Cox, T. J. (2013). Adolescents’ perceptions of their school’s acoustic environment: The development of an evidence based questionnaire. Noise and Health, 15(65), 269. Crandell, C. C., & Smaldino, J. J. (2000). Classroom acoustics for children with normal hearing and with hearing impairment. Language, Speech, and Hearing Services in Schools, 31, 363–370. Goines, L., & Hagler, L. (2007). Noise pollution: A modern plague. Southern Medical Journal, 100(3), 287–293. Halpern, D. (1995). More than bricks and mortar? Mental health and the built environment. London, England: Taylor & Francis. Kargas, N., López, B., Reddy, V., & Morris, P. (2015). The relationship between auditory processing and restricted, repetitive behaviors in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(3), 658–668. Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism: The International Journal of Research and Practice, 4(2), 117. Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M. L. (2012). Effect of classroom modification on attention and engagement of students with autism of dyspraxia. American Journal of Occupational Therapy, 66(5), 511–519. Lane, A. E., Young, R. L., Baker, A. E. Z., & Angley, M. T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism and Developmental Disorders, 40(1), 112–122. http://dx.doi.org/10.1007/s10803-009-0840-2 Ljung, R., Sörqvist, P., & Hygge, S. (2009). Effects of road traffic noise and irrelevant speech onhildren’s reading and mathematical performance. Noise & Health, 11(45), 194–198. Lovaas, O. I., Varni, J. W., Koegel, R. L., & Lorsch, N. (1977). Some observations on the non-extinguishability of children’s speech. Child Development, 48, 1121–1127. Martin, C. (2014). Exploring the impact of the design of the physical classroom environment on young children with autism spectrum disorder (ASD). Journal of Research in Special Education Needs, http://dx.doi.org/10.1111/1471-3802.12092 Melnick, W. (1979). Hearing loss from noise exposure. In C. M. Harris (Ed.), Handbook of noise control. New York: McGraw-Hill Book Company. National Center for Education Statistics. (2013). Digest of education statistics, 2012 (NCES publication No. 2014-015). Washington, D.C: US Government Printing Office. Orekhova, E. V., & Stroganova, T. A. (2014). Arousal and attention re-orienting in autism spectrum disorders: Evidence from auditory event-related potentials. Frontiers in Human Neuroscience, 8(34), 1–17. Persson, R., Kristiansen, J., Lund, S. P., Shibuya, H., & Nielsen, P. M. (2013). Classroom acoustics and hearing ability as determinants for perceived social climate and intentions to stay at work. Noise and Health, 15(67), 446. Shield, B., & Dockrell, J. (2008). The effects of environmental and classroom noise on the academic attainments of primary school children. Journal of the Acoustical Society of America, 123, 133–144. Shield, B., Greenland, E., & Dockrell, J. (2010). Noise in open plan classrooms in primary schools: A review. Noise & Health, 12(49), 225–234. Simons, D., & Chabris, C. (1999). Gorillas in our midst: sustained inattentional blindness for dynamic events. Perception, 28, 1059–1074. Stiegler, L., & Davis, R. (2010). Understanding sound sensitivity in individuals with Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 25(2), 67–75. Stiegler, L., & Davis, R. (2011). Managing sound sensitivity in individuals with ASD. Audiology Journal, 27, 299–312.
Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004
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Suter, A. H. (1989). The effects of noise on performance Tech. Mem. 3-89. Aberdeen Proving Ground, MD: U.S. Army Human Engineering Lab. Swettenham, J., Remington, A., Murphy, P., Feuerstein, M., Grim, K., & Lavie, N. (2014). Seeing the unseen: Autism involves reduced susceptibility to inattentional blindness. Journal of Neuropsychology, 28(4), 563–570. http://dx.doi.org/10.1037/neu0000042 Tammet, D. (2006). Born on a blue day. New York: Free Press. Tang, J., Kennedy, C. H., Koppekin, A., & Caruso, M. (2002). Functional analysis of stereotypical ear covering in a child with autism. Journal of Applied Behavior Analysis, 35(1), 95–98. Tillman, J., Olguin, A., Tuomainen, J., & Swettenham, J. (2015). The effect of visual perceptual load on auditory awareness in Autism Spectrum Disorder. Journal of Developmental Disorders, 45(10), 329–3307. Tomcheck, S. D., Huebner, R. A., & Dunn, W. (2014). Patterns of sensory processing in children with an autism spectrum disorder. Research in Autism Spectrum Disorders, 8(9), 1214–1224. Van Kamp, I., & Davies, H. (2013). Noise and health in vulnerable groups: A review. Noise and Health, 15(64), 153–159. Varni, J. W., Lovaas, O. I., Koegel, R. L., & Everett, N. L. (1979). An analysis of observational learning in autistic and normal children. Journal of Abnormal Child Psychology, 7, 31–43. Varni, J. W., Handen, B. L., Corey-Lisle, P. K., Guo, Z., Manos, G., Ammerman, D. K., et al. (2012). Effect of Aripiprazole 2–15 mg/d on health-related quality of life in the treatment of irritability associated with Autistic Disorder in children: A post hoc analysis of two controlled trials. Clinical Therapeutics, 34, 980–992. World Health Organization. (2016). Training for health care providers: children and noise. Retrieved from. www.who.int/ceh Woolner, P., & Hall, E. (2010). Noise in schools: A holistic approach to the issue International. Journal of Environmental Research and Public Health, 7(8), 3255–3269. http://dx.doi.org/10.3390/ijerph7083255
Please cite this article in press as: Kanakri, S. M., et al. Noise and autism spectrum disorder in children: An exploratory survey. Research in Developmental Disabilities (2017), http://dx.doi.org/10.1016/j.ridd.2017.02.004