Autism – addressing listening in classrooms

Audiologists are becoming increasingly included as members of multidisciplinary teams who manage the hearing difficulties experienced by youth with autism. Audiologists participate in these teams by evaluating hearing and by recommending interventions to improve listening. As the need for our services in these multidisciplinary teams grow, it becomes critical for us to understand the evidence supporting the interventions we might recommend for management plans.

Listening challenges in classrooms

We know that most classrooms are quite noisy; students spend up to 70% of their day listening in noise while in school.¹ We also know that youth with autism can demonstrate differences in sensory function, such as changes in the perception of audiovisual information² and difficulties listening in the presence of background noise.³ Although remote microphone systems have been used successfully for decades for students with hearing loss,^4,5 the consideration for remote microphone systems for youth with autism is a relatively new development in the field.

Remote microphone systems can help youth with autism in the classroom

Several investigations have recently demonstrated that remote microphone systems (RMSs) can benefit youth with autism in classrooms. Benefits have been related to listening-in-noise performance, in addition to improved social interactions, educational achievements, and classroom listening behaviors.^6-10

Although these studies provide general evidence for youth with autism, it is less clear how benefits might be related to an individual person’s RMS benefit. For example, are students who are younger or have lower language scores more likely to benefit from RMSs? Or are students who demonstrate broader autism symptomatology, such as more involved sensory processing differences, less likely to benefit from RMS? Based on the existing studies, we might predict that youth with altered tactile responsiveness might not benefit from RMSs,^6,9,10 but it’s not clear how other characteristics might influence benefit.

Recent evidence from an interdisciplinary team investigating individual benefits

As an interdisciplinary team of audiologists and speech-language pathologists, including Drs. Anne Marie Tharpe and Tiffany Woynaroski, we recently embarked on a series of studies investigating potential benefits of RMSs for youth with autism. Our overarching goal was to evaluate the potential benefits of RMSs for classrooms and to investigate the potential factors that might affect RMS benefits.

For the first study, we were interested in listening-in-noise accuracy (how many syllables, words, or sentences a participant could repeat back) and listening effort (how much mental effort a participant used during the test as measured with a response-time task).¹¹ We recruited and tested 32 youth (7-20 years old) and characterized them on a wide range of variables, including age, language ability, cognition, autism symptomatology, and auditory-visual integration abilities. Participants completed testing in a laboratory that was similar acoustically to one student might encounter in a classroom (moderate reverberation, relatively high noise level of 64 dB SPL, talker’s face was visible).

Our results demonstrated clear and consistent benefits of using the Roger Focus (a remote microphone system with a receiver in one ear and a microphone near the loudspeaker). Average benefits were up to 50 percentage points. In addition, the RMS reduced the mental effort some participants used while they were listening.

However, it wasn’t all youth who demonstrated this cognitive benefit. Only youth who had high language scores and high nonverbal intelligence scores demonstrated listening effort benefits with the RMS. Interestingly, youth with low language and low nonverbal intelligence scores demonstrated more listening effort with the RMS than without it. Importantly, none of the autism-specific listener variables were related to RMS benefits. Participants who demonstrated more autism symptomatology or poorer auditory-visual integration were not less likely to benefit from the RMS. The only critical factors were language ability and nonverbal intelligence.

Clinical implications for youth with autism in the classroom

Combined, our results demonstrate that an RMS can help youth with autism in a noisy, classroom-like environment by increasing the number of syllables, words, and sentences they can accurately repeat. Moreover, youth with high language and non-verbal intelligence scores, the RMS reduced listening effort. Reducing listening effort in classrooms could be very beneficial because it would leave more cognitive resources available for other important school-related tasks, such as comprehension and learning. Conversely, for youth with low language or nonverbal intelligence scores, the RMS increased listening effort. However, this might also be beneficial in classrooms for this population.

If listening was too difficult without the RMS, the student might not be engaged in the task. If the RMS made the task easier and helped the student engage in the listening task, the result would be increased listening effort. Therefore, we believe the RMS can reduce mental effort for youth with high language and nonverbal intelligence scores, and can increase listening engagement for youth with low language and nonverbal intelligence scores.

Based on our work, we did not identify student characteristics that would disqualify them from being RMS candidates. Even those youth who demonstrated pretty broad autism symptomatology and incomplete auditory-visual integration, demonstrated RMS benefits. These results add to the growing body of work providing empirical support for audiologists. With a strong evidence-base to support us, we can be confident that RMSs are a potentially beneficial option to include in our management plans. Our future research plans include examining whether youth with autism demonstrate benefits of RMS in other domains, such as neural efficiency and listening behavior.

To read the full article, see the pre-print version here. To learn more Roger Focus remote microphone systems, including the one used in our study, visit www.phonakpro.com/rogerfocus.

References

1. Crukley, J., Scollie, S. & Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of Educational Audiology, 17: 23-35.
2. Feldman, J.I., et al. (2020). Relations between the McGurk effect, social and communication skill, and autism symptom severity in children with and without autism spectrum disorder. Journal of Autism and Developmental Disabilities.
3. Irwin, J.R., et al. (2011). Can children with autism spectrum disorders “hear” a speaking face? Child Development, 82(5): 1397-1403.
4. Anderson, K.L., et al. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12: p. 14-28.
5. Anderson, K.L. & Goldstein, H. (2004). Speech perception benefits of FM and infrared devices to children with hearing aids in a typical classroom. Language Speech Hearing and Services in Schools, 35(2): p. 169-184.
6. Rance, G. (2014). Wireless technology for children with autism spectrum disorder. Seminars in Hearing, 35(03): 217-226.
7. Rance, G., et al. (2017). Reducing listening-related stress in school-aged children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(7): p. 2010-2022.
8. Schafer, E.C., et al. (2013). Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): An initial investigation. Journal of Communication Disorders, 46(1): p. 30-52.
9. Schafer, E.C., et al. (2019). Effects of auditory training and remote microphone technology on the behavioral performance of children and young adults who have Autism Spectrum Disorder. Journal of the American Academy of Audiology, 30(5): p. 431-443.
10. Schafer, E.C., et al., (2016). Assistive technology evaluations: Remote-microphone technology for children with Autism Spectrum Disorder. Journal of Communication Disorders, 64: p. 1-17.
11. Feldman, J.I., et al., (In press). Remote microphone systems can improve listening-in-noise accuracy and listening effort for youth with autism. Ear and Hearing.