Download Better Understanding of Audiological Test Results in

Better Understanding of Audiological Test Results in Children with ASD
Rebecca Davis & Lillian Stiegler
Southeastern Louisiana University
Common
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Auditory Complaints in Individuals with ASD:
Hypersensitivity to loud or novel stimuli
Difficulty with competing stimuli
Difficulty in background noise
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Inconsistent and/or no responses to auditory stimuli
Challenges in Testing the Child with ASD:
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Behavior issues
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Acceptance of headphones, probe tips, etc.
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Fear of test environment
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Fear of sound
“Hearing is adequate for speech and language development” or Is It?
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Often results are limited to behavioral assessment of the peripheral auditory system
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Does not address issues of auditory processing ability
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Although Autism is a complex neurological disorder, this should not be discounted in management
Solutions:
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Individualize audiological assessment based on the client’s reported symptoms & the challenges they present during testing
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Be persistent
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Be descriptive in impressions of the test results obtained
Patient
1
Results Obtained
WNL
2
Testing Performed
Pure tone, Speech
Audiometry
Sound field VRA
3
ABR, DPOAE, Immittance
4
5
Sound field VRA
screenings on two
separate occasions
ABR
Responses to clicks at 15 dBnHL in both ears; 500 Hz
tonebursts-35 dBnHL in both ears; DPOAEs present in
both ears; tympanometry consistent with patent PE
tubes.
Responses WNL at 1000, 2000, 4000 Hz; speech
awareness threshold at 10 dBHL; body part recognition
– 100%
Absolute and interpeak latencies were WNL and
recorded down to 20 dBnHL; morphology was “infantlike”
6
None
Impressions
“Hearing is within normal limits in both ears”
“Results indicated adequate hearing for speech and
language development.”
“These results are consistent with normal and/or
adequate peripheral hearing sensitivity bilaterally”
No
No
“Hearing is adequate for speech and language
development”
Yes
No
Yes
COR
Inconsistent responses to pure tones
“Bilaterally normal ABR…These threshold levels are
considered to be within normal limits and adequate
for the development of normal speech and language”
“Mother felt that A’s vision and hearing were
satisfactory for assessment purposes”
“Hearing accuity is questionable.”
ABR
“Normal sensitivity but abnormal I-V intervals and
abnormal synchrony.”
Recommend further testing before generating an
impression
8
Pure Tone AC
OAEs
WNL at 500, 1000, 2000, 4000 Hz
Present in both ears
9
Speech Audiometry
SRT in sound field at 10 dB
10
Pure tones,
tympanometry
BAER
WNL
Normal latency-intensity curve
Sound field VRA, speech,
tympanometry,
7
Rx:Further Testing?
No
“hearing acuity is adequate for speech and language
development”
“This indicated that G’s hearing was essentially
within normal limits”
No
Yes
No
Yes, but further
behavioral attempts
were unsuccessful.
Yes
None given
None given
No
Yes
Normal pure tone, speech response at 30 dBHL;
abnormal pressure and compliance
“normal hearing sensitivity bilaterally”
Yes
Immittance
Normal type A tympanograms; ipsilateral reflexes at
90-95 dB
“Normal auditory functioning”
11
TEOAEs
Present bilaterally
“Hearing within normal limits, with no evidence of
any conductive component at this time.”
No
12
Sound field VRA, OAEs,
tympanometry
Minimal responses considered WNL; OAEs present;
tympanometry consistent with PE tubes
“Hearing considered within normal limits”
Yes
“SRTs were within normal limits bilaterally. TEOAES
were present bilaterally, indicating hearing within
normal limits.”
Yes
Speech, TEOAEs
Screening at 20 dB at 500, 1000, 2000, 4000 Hz
“hearing within normal limits”
Screening at 20 dB at 500, 1000, 2000, 4000 Hz
“normal hearing across all frequencies”
“hearing considered within normal limits”
“ [hearing] was within normal limits”
No
No
No
Yes
Hearing evaluation (no
tests identified)
“results were found to be within normal limits”
Yes
ABR (no sedation),
tympanometry
“no significant high frequency hearing loss in either
ear”
Yes
Pure tone air
13
14
15
OAEs present bilaterally
No
Pure tone air x 4
Hearing screening
Could not be conditioned
for hearing screening
Responses to clicks at 15 dBnHL; type A tympanogram
present in the right ear, could not obtain a
tympanogram in the left ear
*Davis, R. & Stiegler, L. (2005). Toward more effective audiological assessment of children with autism spectrum disorders. Seminars in
Hearing, 26, 241-252.
References
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