Little Heroes Pediatric Hearing Clinic

By Dr. JJ

12/01/2021

I recently attended the 2021 American Speech-Language-Hearing Association convention. I learned so much, but one presentation really hit home for me. The topic was Autism and hearing loss, and the discussion was about the serious weaknesses currently happening in pediatric audiology practice when it comes to determining whether hearing differences exist in children with Autism.

Because of the neurological differences in children with Autism, behavior patterns are different. This is well known; however, research is showing that because of these behavior differences, children with Autism are nearly two times more likely to have incomplete audiologic data when having their hearing tested.

What does this mean?

When audiologic data is incomplete, it can mean the child may have a hearing loss that is missed yet contributing to the child’s overall developmental/communicative abilities. When there is missing data concerning a child’s access to sounds, it can result in misplaced intervention services, and progress with interventions may plateau.

How do I make sure that my child’s hearing test is complete?

1. Look for a pediatric audiologist who:
   1. is comfortable working with children with Autism;
   2. is knowledgeable about Autism;
   3. can adapt testing methods to meet the developmental abilities for your child, regardless of their chronological age.
      1. Check out our YouTube videos talking about Visually Reinforced Audiometry and Conditioned Play Audiometry to get a sense of what testing method might be best for your child.
   4. Ask for ear-specific information:
      1. Ask your pediatric audiologist to work hard at getting at least otoacoustic emissions in each ear (they will know what you mean).
      2. If your child is ear-defensive, ask your pediatric audiologist for tips and tricks that can be practiced at home so that a follow-up exam can be scheduled for success.
      3. Ask your pediatric audiologist to create a visual activity board that will clearly show:
         1. What is going to happen during the appointment
         2. When it’s going to happen
         3. How it’s going to happen

3. If there is concern for hearing loss, ask for bone-conduction testing
   1. Bone-conduction testing is what determines the type of hearing loss being observed, which is so important for understanding intervention options. Children with Autism are 1.5 times more likely to lack this test.

What do I do if multiple attempts at a hearing exam fail, and I’m really concerned?

My partner, Dr. Tubaugh, and I recently published a YouTube video talking about sedated auditory brainstem response (ABR) procedure. Hopefully, you are working with a pediatric audiologist who has a lot of tips and tricks up their sleeve to get solid audiologic information in a couple rounds of hearing exams. However, in some cases of concern, the best route is to sedate the child and get a more objective measure of hearing acuity by looking at neurological responses to sounds. Talk to your audiologist if you think this is the choice for you and check out our video on sedated ABRs.

Anything else to know?

Even if your get a full audiologic exam showing normal hearing sensitivity, there are still some things to keep in mind:

1. Children with autism are known to struggle with speech perception, especially in noise. So, even though they can hear all sounds, it may be that a lot of speech sounds are unclear. This can limit their ability to process speech and make meaning. Talk with a pediatric audiologist who has expertise in auditory processing disorders.
   1. Beyond the audiogram, important tests include:
      1. Dichotic listening
      2. Speech-in-noise understanding
   2. Some children with autism may not be good at reporting when they experience changes in their hearing sensitivity. To safeguard against a missed late-onset hearing loss, or a progressive hearing loss, children with Autism should have their hearing evaluated at least annually.
   3. Some children with Autism experience sound sensitivities that may require intervention.

Here at Little Heroes Pediatric Hearing Clinic, we love working with neurodiverse children. We love their energy. We empathize with their sensory struggles. We are here for you! If you are concerned for hearing differences in your child with Autism, please call (801) 996-7510!

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