Autism Spectrum Disorder (ASD) is one of the most common developmental disabilities, with
an estimated 1 in 54 children receiving a diagnosis. The total economic burden of ASD in
the United States is estimated to be $268 billion and will increase to $461 billion by
2025. People with ASD have deficiencies in social relationships and communications and an
increased rate of anxiety disorders, with some estimates suggesting 84% of people with
ASD have anxiety. This anxiety can lead to an individual with ASD to exhibit avoidant
behavior, which can include exclusion from activities to escalated behaviors that could
be self-injurious or harmful to others. These avoidant behaviors can make participation
in activities of daily living challenging for people with ASD, as the avoidant behavior
is often considered socially-unacceptable behavior. While there has been increasing
interest in anxiety in ASD, there is still a major knowledge gap in understanding how
sensory processing disorders play a role in anxiety and if this can be treated.
Sensory Processing in ASD: Sensory processing disorders were added to ASD diagnosis in
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013. Since
then, there has been little research into the role that sensory processing disorders
plays in the anxiety of people with ASD. Functional magnetic resonance imaging (fMRI)
studies have demonstrated that people with ASD have greater brain activity in relevant
sensory areas, the amygdala, and the orbital frontal cortex when exposed to combinations
of unpleasant auditory, tactile, or visual stimuli. Further, people with ASD have a
reduced ability to habituate to the same unpleasant stimuli in the relevant sensory
cortices and amygdala, differences in the changes of brain activity in the
orbital-frontal cortex, and differences in functional connectivity between the amygdala
and orbital-frontal cortex. These brain responses have also been connected with
physiological responses in children with ASD, as those with greater skin conductivity
having reduced neural response in the orbital-frontal cortex and heart rate being
positively correlated with activity in the inferior and medial frontal gyrus.
Even though the neurophysiological evidence supports sensory processing differences in
ASD, current treatment strategies are sparse and the results are often inconsistent. The
most successful paradigm is exposure therapy through systematic desensitization, which
has been used in both ASD and people with anxiety. While multisensory integration skills
may be malleable, it has been suggested that exposure therapy may not be an effective
long-term strategy, as the clinical team cannot perform exposure to every stimulus in
every environment. With this in mind, new therapeutic techniques need to be designed to
enable personalization of exposure experiences.
Virtual Reality for ASD: One emerging technique that could enable quick personalization
of unpleasant stimulus and environments is virtual reality (VR). Therapeutic VR software
has shown to be an effective platform for skill training, mainly focusing on behavioral
skills in social or educational environments. Two investigations demonstrated changes in
neural activity after participating in VR social cognition training. However, the effects
of using VR as a sensory exposure platform on the physiological response to unpleasant
stimuli has not been explored.
Purpose The research objectives of this application are to quantify the
neurophysiological changes that occur after participating in a virtual reality systematic
desensitization protocol. The following aims will be achieved the top physiological
recording devices for ASD to collect physiological responses, front-line virtual reality
systems to provide automated desensitization exposure therapy, and University of Nebraska
Medical Center's research MRI system. 30 people with ASD and 30 neurotypical peers will
be recruited to utilize this software. This proposal will be the first step in developing
evidence-based therapies aimed at addressing sensory processing differences in ASD.