Auditory processing difficulties and ASD

People with Autism Spectrum Disorder (ASD) often experience auditory processing difficulties - such as in understanding speech when there is a lot of background noise, finding it hard to listen with many people talking at the same time, and focusing on verbal instructions. Auditory processing deficits contribute to the social and communication difficulties that people with autism face. Having poor auditory input can reduce one's ability to pick up verbal cues and emotion expression and increase anxiety due to a seemingly overwhelming auditory environment. This can trigger negative behaviours as a means of coping or trying to understand. However ongoing research is showing that treatments used for Auditory Processing Disorder (APD) can be successfully used for individuals with autism too.


Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a genetic condition that affects the development of the brain. People with Autism Spectrum Disorder/Differences (ASD) commonly experience difficulties with communication and social interactions. They may also have restricted and/or repetitive patterns of behaviour. This can affect other aspects of their life - like their language development, education, occupation, and relationships. Perceiving the condition as a ‘spectrum’ reflects how very different and unique all people with autism are from one another.

ASD has one of the fastest growing prevalence rates among clinical conditions. In New Zealand, it affects approximately 1 in 58 people. This includes people who were previously classified as having Asperger’s Syndrome. It is believed that autism affects boys four times more than girls, but there is increasing research showing that girls with autism are under-recognised because they have different behaviours and coping mechanisms. There are also other conditions that often occur, or are diagnosed in association with, autism. Some common ones include:

  • attention deficit (hyperactivity) disorder (AD(H)D)
  • anxiety (obsessive compulsive disorder, attachment disorder)
  • developmental dyspraxia/developmental coordination disorder
  • opposition defiance/conduct disorder
  • epilepsy
  • Tourette syndrome
  • hearing impairment/auditory processing disorder
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Auditory processing difficulties in Autism Spectrum Disorder

The current recommended process of diagnosing autism involves a multidisciplinary team. Professionals from different disciplines look at a combination of the person’s developmental history; behaviours in different settings and with different people; comprehension and reasoning skills; speech and language; mental health; physical health; and any unusual sensory, motor, or coordination issues.

Although a simple hearing assessment is frequently carried out, more complex hearing problems may be missed because of other autism-related behaviours. Auditory processing disorder is a type of hearing loss not related to physical damage to the ears, but to what the brain does with incoming sound. People with autism often experience auditory processing difficulties or have auditory processing disorder (APD).

Some primary auditory processing difficulties include:

  • making sense of speech in the presence of background noise or other people talking to each other
  • poor ability to correctly perceive very brief but important components of speech sounds (for example parts of some consonant sounds are often only a brief fraction of a second in length)
  • difficulty perceiving differences in the pitch of speech sounds.

There may also be hypersensitivity to sound or noise. These problems may underlie other difficulties such as:

  • picking up social cues and understanding the intention of others
  • recognising emotion in others
  • speech and/or language differences/delay
  • increased anxiety or being overwhelmed in noisy environments
  • following complex sentences, or multi-step instructions
  • poor mental health
  • low motivation to communicate with family, teachers, and peers
  • lack of social attention towards others
  • poor academic performance.

How does it sound to have APD?

Adults with APD, particularly if it arose in adulthood so they have prior experience of good hearing, can provide insight into the experience of hearing with APD.

Dr Louise Carroll QSO, JP, GDPPA , MPM, previously Chief Executive Officer of the National Foundation for Deaf and Hard of Hearing has Auditory Processing Disorder and uses hearing aids and a remote microphone (RM) system. She describes her hearing experience as follows.

“Without my hearing aids or RM system, speech seems fast, fragmented and confusing. Voices lack tonality. My directional hearing is poor and voices from behind are particularly difficult to hear. It’s very difficult to distinguish a voice from any other sound that is present. For example, if the refrigerator switches on (a sound barely noticeable to most people) it seems to me to swamp anyone speaking. With my hearing aids I hear much better, losing only perhaps 25% of speech. With both my hearing aids and RM system I can usually hear 100%. But I am still exhausted from listening at the end of the work day and want to take my hearing aids off as soon as I get home.”

One child with APD when first fitted with a remote microphone hearing aid system echoed the comment about lack of tonality in voices. He listened to the teacher and teacher aide for a moment then remarked with surprise that they had different voices. “I didn’t know people had different voices” he said.


Diagnosis of APD

As with autism, a diagnosis of APD requires the evaluation of information from a range of sources. For children suspected of having APD, parents and teachers are asked to provide their perspectives on listening behaviours and auditory skills or problems. For adults suspected of having APD, information from questionnaires can be used to supplement case history information.

A confirmed diagnosis of APD requires a specialised battery of audiological tests administered and interpreted by an audiologist. These tests include:

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  • standard hearing tests to rule out “peripheral” hearing loss (hearing disorders in the outer, middle or inner ear)
  • cognitive screening (to assess whether cognitive difficulties contribute to the problem)
  • language screening (to make sure the problem is auditory, and not due to language impairment or problems with understanding instructions for the APD tests)
  • repeating back words or sentences in the presence of background noise or competing speakers
  • repeating back words or sentences when there is different information going to both ears at the same time (dichotic listening - to see if there is an issue such as imbalance between the two ears leading to excessive dominance by one ear)
  • repeating back short patterns of high and low tones (to see how well the brain can distinguish differences in pitch and whether it is able to retain sequences of sounds in the correct order).

Treatment

Ongoing research shows that treatments used for APD can be successfully used for autism too. Most notable is the use of assistive listening devices, in particular remote microphone hearing aid (RMHA) systems. Some forms of auditory training are also useful. Examples of research findings in studies looking at treatment of auditory processing difficulties in autism include:

  • using RMHA systems improved speech perception in background noise and ease of communication between the child with autism and their teacher in the classroom
  • using RMHA systems improved listening, communication, and social interactions; and reduced stress levels (measured by cortisol level in saliva), indicating less anxiety for children with autism in a noisy classroom environment
  • using RMHA systems resulted in better speech recognition in noise, increased on-task behaviours, and improved teacher ratings of listening behaviours
  • less listening difficulty at home and school was reported respectively by parents and teachers of children with autism when they used RMHA systems
  • following a 12-week auditory processing training programme, with one-on-one therapist-direction and the use of RMHA systems, children and young adults with autism showed improved abilities to hear and remember auditory information when there was competing speech arriving at both ears at once
  • following a 3-week computer-based training programme aimed at teaching emotion and social perception, children with autism who wore RMHA systems during training had longer lasting improvements compared to a group who did not wear RMHA systems
  • children with autism who took part in 3 weeks of emotion perception training while wearing RMHA systems showed changes in brain activity that indicated that their brains had learned to distinguish between emotional tones in people’s voices
  • in children with autism, dichotic auditory training (competing information to the two ears) was effective in correcting auditory processing imbalance between the ears and had other beneficial effects on the perception of speech sounds.

How can SoundSkills help individuals with Autism Spectrum Disorder?

SoundSkills is a service specialising in the diagnosis and treatment of auditory processing disorders and difficulties. The team of experts at SoundSkills includes audiologists, a speech-language therapist, a special education adviser, and a psychology research fellow specialising in autism. An auditory processing assessment at SoundSkills includes a full battery of auditory processing tests, as well as comprehensive review of observations of parents, teachers, and other professionals working with the individual.

A range of scientifically validated treatment options - including RMHA system trials, auditory training, and speech-language therapy - are offered by the team at SoundSkills. Support, including school and sometimes home visits, can be provided to ensure the best possible outcome in effectively managing auditory processing difficulties in children with ASD.

The team at SoundSkills has resources and methods for working with individuals with a range of conditions. For autism in particular, difficulties addressed include helping individuals become accustomed to wearing headphones in order to undertake auditory processing testing, and use of strategies to help children stay engaged on lengthy or demanding auditory tasks. The team at SoundSkills is flexible and prepared to work through a customised process to help the individual succeed in achieving an auditory processing assessment, and if diagnosed, successfully participate in treatment.

Team members at SoundSkills are affiliated with experts at university programmes specialising in APD and ASD at the University of Memphis (USA), the University of North Texas (USA), the University of Melbourne (Australia), and the University of Auckland (New Zealand), and are actively engaged in ongoing research in these areas.

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