Pediatrics, Clinical Practice

Do children with autism listen differently?

Audiologists possess a unique skill set that can aid in the assessment and management of listening challenges commonly experienced by children with autism.

Historically, audiologists have played a more limited role in the multidisciplinary care teams who serve children with autism spectrum disorder (ASD). The audiologist’s participation in a child’s evaluation and management is most often limited to an audiologic assessment to “rule out” hearing loss as a contributing factor to speech and language delays.

However, research has suggested that some children with ASD achieve poorer performance on tests of auditory function than their typically developing peers, despite having normal pure-tone audiograms.1-3  Specifically, studies have suggested that children with autism may experience difficulty with over- or under-sensitivity to sound, difficulty processing oral directions, deficits on auditory tests of temporal processing, and poor speech recognition in the presence of background noise.4,1,5

Over the past few years, several researchers have investigated the difficulties children with ASD might experience in complex listening environments as well as possible intervention options that could benefit this unique population. A number of studies have suggested that children who have been diagnosed with ASD and present with deficits on tests of auditory function (specifically in the area of speech recognition in noise) might benefit from using remote microphone technology in complex listening environments. 1-3  The use of remote microphone technology improves the signal-to-noise ratio of the incoming target stimuli, potentially increasing the salience of the speech of the talker of interest and minimizing the interference of noise.

Assessing auditory differences experienced by children with autism spectrum disorder

The encompassing term ‘auditory processing’ can be divided into different areas, including understanding speech in the presence of background noise, auditory filtering, working memory and comprehension, spatial processing, temporal processing, binaural integration, etc. These auditory processing subcategories are often correlated, but there might be additional factors that influence a child’s performance on auditory processing tests, including but not limited to, attention, expressive and receptive language abilities, cognitive abilities, anxiety and behavioral disorders, and other co-existing disabilities or diagnoses. When working with children with autism, comorbid diagnoses are common and must remain in the forefront of the clinician’s mind when interpreting test results. Consequently, it is imperative to note that although children who have been diagnosed with ASD often exhibit deficits on tests of auditory processing, there is insufficient evidence to suggest that these children should have an additional diagnosis of an auditory processing disorder as defined by the American Speech and Hearing Association (ASHA).

Due to the impact additional diagnoses and behavioral deficits can have on a child’s ability to reliably complete diagnostic audiology assessments, as well as the child’s ability to accept and adapt to intervention options, audiologists, speech language pathologists, educators, and other professionals must work together to assess and manage the auditory deficits present in this population.

In 2013, In one study, Schafer and colleagues found that 11 children with a diagnosis of ASD and attention deficit hyperactivity disorder (ADHD) performed significantly poorer on a speech recognition task in noise compared to age-matched neurotypical peers.2 In a later study, Schafer and a different group of colleagues found that 13 children with a diagnosis of ASD also performed significantly poorer than age-matched neurotypical peers on tasks of auditory memory and auditory comprehension.3

Tomchek and Dunn asked the parents of 400 children, ages 3 – 10 years with a diagnosis of ASD, to complete the Short Sensory Profile (SSP).5 Nearly 60-80% of the participants exhibited deficits in their auditory filtering abilities, were distractible, experienced significant deficits in noisy or more complex listening environments, had difficulty attending to auditory stimuli, and were under-responsive to auditory stimuli compared to neurotypical peers. Moreover, Ashburner et al., identified that a child’s under-responsiveness to auditory stimuli and auditory filtering deficits were highly correlated with the child’s academic performance, learning, and attention deficits.4

Intervention options available for children with ASD

Rance and colleagues evaluated auditory processing skills in a group of children with ASD to assess the benefit of implementing remote microphone systems in the classroom in ameliorating listening difficulties.1 This study found that use of remote microphone technology resulted in improved speech perception in noise and improvements in a variety of different behaviors as indicated by results on participant and teacher questionnaires. 80% of participants who completed the remote microphone trial remained consistent users of the technology following completion of the study. Schafer and colleagues also utilized functional questionnaires to assess benefit from remote microphone technology for children with ASD and found that average results from these questionnaires indicated children with ASD may benefit from remote microphone use in the classroom, at home, and in a variety of social situations.3

Audiologists are appropriately trained to assess a child’s speech perception ability in complex listening environments in combination with other areas of auditory processing. The findings from the Rance et al. and Schafer et al. studies highlight a possible opportunity for the audiology profession to positively impact the care and intervention options available for children with ASD.1,3 It is essential for the audiology community to have a thorough understanding of an appropriate test battery to evaluate the functional auditory abilities of children with ASD. Audiologists also must understand the influence that additional diagnoses, cognition, and behavioral abilities have on a child’s performance on traditionally administered tests of auditory processing. It is equally important for audiologists to understand the essential need for other members of the multidisciplinary team (e.g., speech pathologists, behavioral therapists, occupational therapists) to accurately evaluate and ultimately carry out recommended interventions.

Multicenter project underway

Currently, a multisite team, comprised of individuals from the University of North Texas, University of Melbourne, and Hearts for Hearing, is working to develop a clinical model for the evaluation and management of the listening differences of children with ASD. This work, along with the work of many other researchers, will hopefully allow the profession of audiology to better serve the needs of children with ASD.

For more information on this topic, please visit autism.phonak.com to learn more about the clinics working within the multisite project aiming to assess auditory challenges children with ASD may experience.

 

To learn about Roger™ microphone technology and how it has been proven to help children with autism, visit phonakpro.com.

 

References:

  1. Rance, G., Saunders, K., Carew, P., Johansson, M., & Tan, J. (2014). The use of listening devices for ameliorate auditory deficits in children with autism. The Journal of Pediatrics, 164, 352-357.
  2. Schafer, E. C., Matthews, L., Mehta, S., Hill, M., Munoz, A., Bishop, R., & Moloney, M. (2013). Personal FM system for children with autism spectrum disorder (ASD) and/or attention-deficit hyperactivity disorder (ADHD): An initial investigation. Journal of Communication Disorders, 1, 30-52.
  3. Schafer, E. C., Wright, S., Anderson, C., Jones, J., Pitts, K., Bryant D., … Reed, P. R. (2016). Assistive technology evaluations: Remote-microphone technology for children with autism spectrum disorder. Journal of Communication Disorders, 64, 1-17.
  4. Ashburner, J., Rodger, S., & Ziviani, J. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62, 564-573.
  5. Tomcheck, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the short sensory profile. American Journal of Occupational Therapy, 61, 190-200.
  6. Schafer, E. C., Gopal, K. V., Matthews, L., Thompson, S., Kaiser, K., McCullough, S., … Hutcheson, A. (2019). Effects of auditory training and remote-microphone technology on behavioral performance of children and young adults who have autism spectrum disorder. Journal of the American Academy of Audiology, 5, 431-443.

 

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