Listening Difficulties in Children with Autism Spectrum Disorder
Schafer, Erin C. PhD; Mathews, Lauren MS; Dunn, Andrea AuD, PhD; Author Information
reprint: The Hearing Journal: April 2021 – Volume 74 – Issue 4 – p 46,47
Even when presenting with normal pure-tone hearing sensitivity, many individuals with autism spectrum disorder (ASD) experience listening and communication issues likely stemming from abnormal auditory processing of speech sounds.1 Listening deficits are also evident in parent/teacher observations, self-report, and behavioral test measures of auditory processing.2,3 Given the deleterious impact of these auditory deficits on understanding and communication in everyday situations, like noisy school classrooms, hearing health care professionals have the unique opportunity to document these deficits and to recommend strategies to mitigate the effects.
This article provides a brief overview of the measurable behavioral, observed, and self-reported deficits in individuals with ASD; discusses the need for a streamlined protocol for assessing listening difficulties in this population; and summarizes the evidence-based interventions available to address these listening deficits.
BEHAVIORAL & SUBJECTIVE DEFICITS
Observed and self-reported auditory deficits in individuals with ASD include poor auditory attention and filtering as well as distractibility, dysfunction, or unresponsiveness to speech signals in noisy environments.2,3 Auditory filtering, or the ability to hear, function, and complete tasks in background noise, is particularly important for children with ASD because better performance is associated with higher academic performance and improved attention.3 On behavioral tasks of auditory processing, children and young adults with ASD exhibit significantly poorer speech recognition in noise, temporal processing of amplitude variations, binaural integration (dichotic listening), and spatial stream segregation (i.e., use of spatial or vocal cues).4-14 When compared to control groups with neurotypical functioning, average speech-in-noise deficits in groups with ASD were 2-8 dB greater, which can substantially impair communication in everyday noisy environments.2,8,11,13 Such behavioral auditory deficits are unlikely to exist in isolation; co-morbid conditions such as attention deficits, language disorders, and anxiety, for example, may also contribute to processing and communication issues.
EVIDENCE-BASED INTERVENTIONS FOR AUDITORY DEFICITS
Two main approaches have emerged for managing auditory deficits in children and young adults with ASD and normal-hearing sensitivity: wireless remote microphone technology (RM) and auditory training. RM systems, consisting of open-fit, ear-level receivers for the listener and a transmitter/microphone for the primary talker, substantially improve the SNR delivered wirelessly to the listener’s ear. As a result, our research and those of others show that RM-system use significantly improves on-task behaviors, teacher- and parent-rated auditory listening behaviors, acceptance of noise, speech recognition in noise, auditory comprehension, physiologic stress levels, and self-perceived listening difficulty.7-15 In addition to RM systems, speech-in-noise training (i.e., word/sentence recognition and comprehension tasks) and dichotic listening training may improve auditory and language processing.9,16-18 Auditory training may be conducted by qualified audiologists, speech-language pathologists, or via online training programs.
EFFICIENT PROTOCOL TO IDENTIFY AUDITORY DEFICITS
Despite the strong evidence of auditory deficits in individuals with ASD, and the availability of evidence-based management (i.e., technology and training), currently, no evidence-based clinical protocols exist to document these issues. An efficient and sensitive assessment protocol is paramount because documentation of listening issues may be required by school districts or insurance companies to secure funds for hearing assistive technology (i.e., remote microphone systems) to improve the signal-to-noise ratio (SNR) in noisy environments like classrooms. To identify the most sensitive auditory assessments for this population, we are in the process of retrospectively analyzing data from over 70 children, ages 6 and 15 years, with ASD who were seen clinically for reported listening issues. Preliminary analyses indicate that, among the assessments, tests of speech recognition in noise and binaural integration, identified significant performance deficits in over one-third of the children when compared to normative data. Group differences were not associated with language ability or attention. Results of this study are expected to yield a recommended clinical protocol for documenting listening difficulties that can be managed with evidence-based interventions.
Hearing health care professions have the opportunity to more effectively serve the population of children and young adults who have normal hearing and ASD, most of which experience auditory processing and communication issues. A stepwise approach for identifying auditory issues and recommending evidence-based interventions for children with ASD is provided in Table 1. Future research is needed to document the most sensitive and efficient approach to assessing and managing listening difficulties in this population. In addition, clinical intervention strategies focused on other aspects of auditory functioning in ASD, such as temporal processing and spatial stream segregation, are also needed.
REFERENCES
- Russo N, Nicol T, Trommer B, Zecker S, Kraus N. (2009) Brainstem transcription of speech is disrupted in children with autism spectrum disorders. Dev Sci 12(4): 557-567.
- Tomchek SD, Dunn W. (2007) Sensory processing in children with and without autism: a comparative study using the short sensory profile. Am J OccupTher 61(2):190-200.
- Ashburner J, Rodger S, Ziviani J. (2008) Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. Am J Occup Ther 62: 564-573.
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