Reducing Listening-Related Stress in School-Aged Children with Autism Spectrum Disorder

The use of remote microphone hearing aid systems reduced listening stress as measured by salivary cortisol and provided a range of benefits for children with ASD.

Rance, G., Chisari, D., Saunders, K., & Rault, J. L. (2017). Reducing listening-related stress in school-aged children with autism spectrum disorder. Journal of autism and developmental disorders, 47(7), 2010-2022.

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Remote microphone hearing aid systems assist hearing in some adult stroke patients

10-week use of remote microphone hearing aid systems by adult patients with stroke may lead to benefits in unaided speech in noise perception. The findings may indicate auditory plasticity type changes and require further investigation.

Koohi, N., Vickers, D., Warren, J., Werring, D., & Bamiou, D. E. (2017). Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study. BMJ open, 7(4), e013003.

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Assistive and Therapeutic Effects of Amplification for Auditory Processing Disorder

Studies of the effects of amplification with remote microphone hearing aid systems for children with auditory processing disorder or dyslexia consistently show therapeutic as well as assistive benefits from the amplification.

Keith, W. J., & Purdy, S. C. (2014, February). Assistive and therapeutic effects of amplification for auditory processing disorder. In Seminars in Hearing (Vol. 35, No. 01, pp. 027-038). Thieme Medical Publishers.

Studies of the effects of amplification with remote microphone hearing aids for children with auditory processing disorder or dyslexia consistently show therapeutic as well as assistive benefits from the amplification. The immediate assistive benefits include improved attention, learning, behavior and participation in class, and improved self-esteem and psychosocial development. The long-term therapeutic benefits include improvements in cortical auditory evoked potential amplitudes to tone stimuli, auditory brainstem responses to speech stimuli, frequency discrimination, binaural temporal resolution, frequency pattern recognition, auditory working memory, core language, phonological awareness, and speech perception in spatially separated noise. Amplification appears to treat a wide range of auditory skills simultaneously, facilitating neuroplastic change while also providing access to the auditory world. Expert intervention to engage the support of teachers is a critical element in achieving successful outcomes. Children treated with remote microphone hearing aids may not require long-term amplification.

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Benefits of prosody perception training and use of remote microphone hearing aid systems for children with Autism Spectrum Disorder

The PhD thesis research of Dr Joan Leung, Adviser: ASD at SoundSkills APD Clinic, showed that children with ASD can improve their communication skills through training to better appreciate prosody, the subtle changes in speech intonation and stress that denote emotion. Use of remote microphone hearing aid systems assisted the prosody perception training and were beneficial to the children in school.

Assessing and training affective prosody perception and production in children with Autism Spectrum Disorder: A Behavioural and neurophysiological Exploration into the Use of Computer-Based Activities and Remote Microphone Hearing Aids for Auditory Processing

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Children with suspected auditory processing disorder show reduced amplitude acoustic reflex growth functions

Measurement of acoustic reflexes is an objective (physiological) test as distinct from behavioural tests used for diagnosing APD. Reduced amplitude acoustic reflex functions in children suspected of having APD provide objective evidence of atypical function in the central auditory nervous system in these children.

Saxena, U., Allan, C., & Allen, P. (2015). Crossed and uncrossed acoustic reflex growth functions in normal-hearing adults, typically developing children, and children with suspected auditory processing disorder. International journal of audiology, 54(9), 620-626.

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Research evidence of the benefit of a software training programme in game format to improve the hearing in noise ability of children with spatial processing disorder, a type of APD

Colleagues at the National Acoustic Laboratories in Australia developed this evidence-based training game to improve ability to hear in noise. The game aspect of the software has since been revised to make it more appealing and it is now marketed as ‘Sound Storm’.

Cameron, S., & Dillon, H. (2011). Development and evaluation of the LiSN & learn auditory training software for deficit-specific remediation of binaural processing deficits in children: preliminary findings. Journal of the American Academy of Audiology, 22(10), 678-696.

The LiSN & Learn auditory training software was developed to improve binaural processing skills in children with suspected central auditory processing disorder who were diagnosed as having a spatial processing disorder (SPD). SPD is a condition whereby individuals are deficient in their ability to use binaural cues to selectively attend to sounds arriving from one direction while simultaneously suppressing sounds arriving from another. As a result, children with SPD have difficulty understanding speech in noisy environments, such as in the classroom.

LiSN & Learn produces a three-dimensional auditory environment under headphones on the user’s home computer. The child’s task is to identify a word from a target sentence presented in background noise. A weighted up-down adaptive procedure is used to adjust the signal level of the target based on the participant’s response.

Participants trained on the LiSN & Learn for 15 min per day for 12 weeks.

On average, speech reception thresholds on the LiSN & Learn improved by 10 dB over the course of training. Significant improvements were found post-training on measures of memory, on one measure of attention, and on self-reported ratings of listening ability. Children as young as 6 years of age of age were able to complete the training. Both parents and children reported benefits from the training.

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Conferences and seminars in 2020

2020 was a promising year for participation at conferences with sessions on auditory processing disorder (APD), until a world pandemic resulted in the cancellation of most conferences internationally. Dr Bill Keith, Director of SoundSkills, was planning to report APD research findings at the Hearing Across the Lifespan (HeAL) conference in northern Italy, and the American Academy of Audiology annual conference in New Orleans, both at venues that were early Covid 19 hotspots. Both conferences were cancelled. The HeAL conference has been rescheduled for mid 2021 and the AAA 2021 Convention will be held as an online conference. An Australia-New Zealand online audiology conference was hastily arranged and Prof Suzanne Purdy and Dr Keith made a joint presentation on New Zealand APD research. Dr Keith also presented on APD at New Zealand conferences of paediatricians (live), educational psychologists (online), and Ear Nose and Throat Surgeons (live). APD teaching for audiology and speech-language students at the University of Auckland was all conducted online. SoundSkills staff conducted seminars for various groups including resource teachers for learning and behaviour (RTLBs), the Raukatauri Music Therapy Centre, and parent seminars.

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Treating auditory processing difficulties in children with autism spectrum disorder (ASD)

Children with autism spectrum disorder (ASD) frequently also have auditory processing difficulties which affect their ability to hear and communicate especially in difficult listening situations such as when there is other conversation or noise going on. The auditory processing difficulties may also affect ability to hear prosody in speech, that is the changes in tone and emphasis that add meaning to spoken language and help us distinguish the emotion associated with a statement and whether or not it is a question or is spoken with humour. Complex auditory environments are stressful for children with ASD as they are also for many children with APD. SoundSkills is participating in a project with APD and ASD experts at the University of North Texas and the University of Melbourne to diagnose and treat auditory processing deficits in children with ASD. The project is supported by hearing instrument company Sonova.

Research at the University of Melbourne has shown that wearing remote microphone hearing aid systems in class reduces listening stress for children with ASD. Research at the University of North Texas has shown that children with ASD benefit from auditory training and the use of remote microphone hearing aid systems. Research by Dr Joan Leung at the University of Auckland has shown that children with ASD can improve their understanding of prosody with training, and that this training progresses faster if they wear remote microphone hearing aid systems. All this research shows that many children with ASD can be helped to hear and communicate better.

Dr Leung is also the ASD Adviser on the staff of SoundSkills and has been working with SoundSkills clinicians to develop their skills and protocols for working with children with ASD, and diagnosing and treating their auditory processing difficulties.

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Current APD research at SoundSkills and the University of Auckland

Data analysis for five research projects funded by the William Demant (previously Oticon) Foundation and carried out by SoundSkills and the University of Auckland has been completed and writing up the results for publication in scientific journals has begun. The projects investigated:

  • actual and optimal duration of use of remote microphone hearing aid systems by children with APD
  • actual and preferred listening levels of remote microphone hearing aid systems by children with APD
  • the effects of different levels of loudness on auditory memory, the auditory brainstem response and speech perception in quiet by children with APD
  • quantification of degree of disability for APD
  • phonological perception training for children with APD both with and without remote microphone hearing aid systems

A project currently in progress is examining whether it is possible to correct amblyaudia, suppression of input from one ear by the brain in difficult listening situations (the auditory equivalent of ‘lazy’ eye), by gradually varying the loudness difference between the weak ear and strong ear over a matter of weeks in children with APD wearing remote microphone hearing aid systems. Professor Suzanne Purdy at the University of Auckland has a number of APD research projects underway including measuring brain function in children with APD using functional magnetic resonance imaging (fMRI), and benefits of auditory training for older adults with mild cognitive impairment. Auditory neuroscience colleagues in the Eisdell Moore Hearing and Balance Research Centre are measuring electrical brain responses to sounds in mice with autism traits to better understand the effects of autism on the central auditory nervous system of the brain.

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