Experiences of others with sensory issues (elderly control group)

6.1 Introduction

Although sensory issues appear to be an integral part of ASD (Ben-Sasson et al., 2009), they are not exclusive to the autism spectrum. For example, individuals with Fragile X Syndrome (FXS) (a genetic condition which causes intellectual disability and

physical/behavioural atypicalities) often display over-responsiveness to sensory

stimulation (Scharfenaker, O'Connor, Stackhouse, Braden, & Gray, 2002). In addition, Miller et al. (1999) found that, for those with FXS, electrodermal responses to sensory stimulation were significantly different from those of TD controls, including being significantly larger, more frequent and demonstrating poorer adaptation to stimuli. This result suggests that individuals with FXS experience a physiologically elevated response to sensory stimuli. Moreover, there has been evidence that mice with Fragile X (instigated by knocking out their FMR-1 gene) develop auditory hyper-responsiveness (Chen & Toth, 2001). As well as those with FXS (Baranek, 2002; Rogers et al., 2003), there is evidence that those with ADHD display unusual responses to sensory stimuli. Using the Sensory Profile (SP: Dunn, 1999) and the Short Sensory Profile (SSP: McIntosh, Miller, & Shyu, 1999) researchers found that those with ADHD demonstrate different sensory

responsiveness compared to typically developing children (Dunn & Bennett, 2002;

Mangeot et al., 2001; Yochman, Parush, & Ornoy, 2004).

Some researchers have developed the idea that the sensory sensitivity exhibited by some individuals is related to the concept of a ‘highly sensitive person’. The Highly Sensitive Person Scale (HSPS: Aron & Aron, 1997) measures the ‘sensitivity’ of a person and includes items targeting emotional as well as physiological sensitivity. Smolewska, McCabe, & Woody (2006) found that the HSPS appeared to have three separate factors (ease of excitation, aesthetic sensitivity and low sensitivity threshold), rather than the single dimensional scale suggested by Aron & Aron (1997). These factors correspond to a) how easily excited someone is (with more sensitive people being aroused more easily), b) an appreciation of aesthetic attractiveness (e.g. art) and c) lower perceptual thresholds.

However, one drawback with this scale is that reports of greater sensitivity do not

necessarily correspond with lower thresholds, at least in the olfactory (Caccappolo et al., 2000; Doty, Deems, Frye, Pelberg, & Shapiro, 1988; Nordin, Martinkauppi, & Olofsson,

2005) and auditory (Khalfa et al., 2004) domains. However, there have been some interesting results using the HSP Scale. Jagiellowicz et al. (2011) recently found that people with higher sensitivity exhibited greater neural activation in areas implicated in higher order visual processing (e.g. right claustrum, left occipitotemporal, bilateral temporal and medial and posterior parietal regions), despite no difference in the accuracy of the change detection behavioural task. Liss, Mailloux, & Erchull (2008) also found that two aspects of the HSPS (EOE and LST) were related to autism symptoms (measured by the AQ), and that these aspects were conceptually different from aesthetic sensitivity (AES). Thus, it would have been interesting if Jagiellowicz et al. (2011) had controlled for AQ score in their study, in order to see whether there was a relationship between the HSPS and level of autistic traits.

However, it is not only increased sensitivity to stimuli that can be difficult for people to cope with. Those with diminished sensory sensitivity also experience difficulties in their everyday lives. This is particularly relevant to ASD as individuals on the spectrum experience both over- and under-responsiveness to sensory stimuli (Baranek et al., 2006;

Leekam et al., 2007). There is evidence that hearing loss can reduce independence and increase the need to rely upon familial or community support (Schneider et al., 2010). In addition, Wauters & Knoors (2007) reported that children with hearing impairments have lower levels of social competence than their peers (despite similar levels of peer

acceptance and friendship relations). Specifically, they had lower levels of prosocial behaviour (i.e. voluntary behaviour which helps others) and higher levels of socially withdrawn behaviour. In a study investigating the experiences of deaf adolescents, results indicated that those with hearing difficulties reported more symptoms of depression than their hearing counterparts (Watt & Davis, 1991). Furthermore, hearing loss is common as we age, particularly the ability to hear higher frequencies (Willott, 1991). There is

evidence that hearing loss has implications for communication (Heine, Erber, Osborn, &

Browning, 2002), as well as an impact upon the quality of social relationships (Nunes, Pretzlik, & Olsson, 2001).

However, audition is not the only sense in which a loss of sensitivity can cause difficulties.

Vision often changes dramatically as we age, with acuity, contrast sensitivity and light sensitivity diminishing in older age (Fozard, 1990). In addition, various ocular diseases (e.g. cataracts, glaucoma and age-related macular degeneration) can cause visual

occlusion, or even vision loss. Clark, Bond, & Sanchez (1999) investigated hearing and vision loss in aging adults. They found that visual impairment (rather than auditory) was

associated with a reduction in ability to carry out basic domestic chores. In males, there was also a reduction in frequency of social and leisure activities. However, the authors stress that it is important to take into account that these changes may be age-related, rather than purely a result of vision loss. Furthermore, Legault, Gagné, Rhoualem, & Anderson-Gosselin (2010) assessed the effect that blurred vision could have on auditory-visual perception in both younger and older adults. Results showed that loss of visual cues was associated with compromised speech understanding. In turn, this would mean that vision problems might make it harder to communicate when someone has hearing loss (because they would be less able to lip-read/use other visual cues etc.). Lastly, there is also

evidence that there is a high prevalence of olfactory impairment in elderly people, and that sensitivity decreases with age (Murphy, 2002). While a loss of olfactory functioning is often an indicator of dementia (McCaffrey, Duff, & Solomon, 2000; Murphy et al., 1990), elderly people without dementia also experience diminished olfactory ability (Murphy, 2002). There are safety concerns associated with loss of olfactory ability, including problems smelling gas leaks or smoke – this becomes especially important if the older adult lives alone.

Elderly individuals are often described as being at risk of increased isolation as they age (Golden et al., 2009). We were interested in determining how sensory loss in elderly adults was related to social interaction and, as such, whether the link between atypical sensory processing and social functioning observed in previous chapters (Chapters 3-5) was also apparent in a non-ASD sample. An important aim was to determine whether there were any commonalities between the experiences of those with diminished sensory ability and both children (see Chapter 4) and adults (see Chapter 5) with ASD. In order to better understand the sensory experiences of elderly people (we defined this as over the age of 60 as the United Nations use 60 years as a cut off to refer to the older population) (World Health Organization, 2012), a group discussion with carers of those with dementia was carried out. Both first-hand and second-hand data were collected in this group

discussion, and they will be reported separately in section 6.3.

6.2 Methods

6.2.1 – Participants

A convenience sample of those caring for individuals with dementia was used (consisting of a support group). The purpose of the meeting is to provide peer support in a friendly environment. At the time of the study, the support group had been in existence for

approximately 8 months and consisted of members who attended on a monthly basis. Staff (n=1) and volunteers from local care (n=1) and dementia (n=1) charities were also on hand to provide support. As they were interested in the topic, they were invited to participate in the discussion. 12/16 participants were over the age of 60 years (which is the age deemed

‘elderly’ by the UN).

6.2.2 – Stimuli

The group was asked three questions throughout the course of the discussion:

1. It is well known that we become less able to sense things as we age … is this something that you've noticed and, if so, what impact has it had on your life?

2. Some people say that if their senses change it can affect their relationships in some way … is this something that you've ever experienced?

3. Are there any places that you visit, or normal daily activities that you now find problematic because of sensory issues, and if so, what is it that makes them problematic?