Managing Hearing and Listening Issues in Children with ASD

If your child shows signs of listening difficulties but tests show good hearing ability, perhaps this article will guide you in finding the right intervention.

“My son has difficulty listening, but his hearing test came back normal.”

This is the sentiment I often hear from parents whose children are on the autism spectrum. Their child is struggling in school, having trouble listening and engaging. They head off to see a hearing healthcare provider, but when their child’s hearing test results come back normal, they can’t figure out why they are still having hearing issues.

Fortunately, recent research has dug into this issue and helped us understand what so many children with autism spectrum disorder (ASD) are experiencing—functional listening issues. In other words, these children have normal hearing sensitivity, but auditory deficits such as impaired auditory filtering make it difficult to hear, function, and complete tasks in the presence of background noise (Ashburner et al. 2008).

How do I recognize functional listening issues?

Many parents of kids with ASD report noticing auditory issues. A recent study revealed auditory filtering deficits were among the most common parent-reported sensory issues and, even more importantly, that these deficits were associated with academic underachievement. (Ashburner et al, 2008).

However, recognizing listening issues can be tricky because the signs also mirror symptoms of traditional hearing loss with ASD. Reduced responsiveness, especially in noisy places, is a key indicator.

• Is your child less likely to respond to their name?
• Are they less likely to engage in conversation?
• Do they experience behavioral challenges related to a lack of listening?

These may be signs of listening issues that can contribute to communication challenges at home, school, and in social settings.

One of the hallmarks of functional listening issues is difficulty understanding speech in complex noise settings. Think of the typical classroom where others are talking, moving about, and shuffling papers. Children with ASD often have much more difficulty recognizing speech in noisy places and experience heightened sensitivity to noise.

Listening in busy settings requires different skills and can be more challenging than simply detecting a quiet tone during a hearing assessment in a soundproof room. The good news is there is emerging evidence that listening challenges can be managed with auditory training and technology.

What types of technology might be useful for my child?

Recently, the use of remote microphone technology has been studied in children with autism who have normal hearing sensitivity. This technology can help children to hear their teacher or parent and overcome challenges from background noise, distance, and poor room acoustics. The technology fits into two overarching categories: soundfield and personal systems.

• Soundfield remote microphone technology or classroom audio distribution systems are often used in schools or large group settings. The teacher or speaker wears a small microphone that picks up their voice and wirelessly transmits the signal to a loudspeaker strategically positioned in the room

  A recent study in a subset of preschool children with ASD and lower language ability showed improved functional listening performance when using a soundfield remote microphone system compared to no technology (Keller et al., 2020)

• Personal remote microphone technology, sometimes referred to as ear-level FM technology, can be used in school, home, and social settings. The teacher or parent wears a microphone that picks up their voice and sends it directly to the child’s ear through a device worn by the child. One study found improved speech recognition in noise in children with ASD using personal remote microphone technology compared to no device, and improved acceptable noise levels (noise tolerance) in a subset of children with ASD when using the device (Schafer et al., 2014). Another found improved speech recognition in noise and reduced cortisol concentration (lower listening stress), when listening in noise with a device compared to no device, as well as parent-reported improvements in ease of communication and hearing in background noise (Rance et al., 2017)

Before you get to the technology solution, you need to take the first step: if you suspect your child has listening issues, request an evaluation from a qualified pediatric or educational audiologist. If you uncover listening issues, discuss management options such as remote microphone technology or auditory training to find the solution that works best for your child’s specific needs.

We Suspect Listening Difficulties, Now What?

1. Seek out a pediatric or educational audiologist—and if you can, find one that works with kids who have ASD. This is an emerging field of study and having an expert in pediatric audiology will help ensure you are linked to the latest research and developments
2. Tap into your schools—work with your schools to find out what exists and what resources, including technology, are available for you to leverage
3. Enlist your child’s educators and school in the effort—Especially during this hybrid/remote learning time and with masks being worn in school, the classroom is an increasingly difficult environment for kids with hearing or listening issues. IEPs and 504 plans were not created with social distancing, masking and remote learning in mind. Engage your child’s teacher(s) and work together to ensure any adjustments that need to be made will help promote access to the curriculum
4. Don’t fear technology—A common concern we hear about personal remote microphone technology surrounds tactile or noise sensitivities. Understandably, some parents are afraid their children with ASD won’t wear ear-level devices. During a recent Phonak study on remote microphone technology in older children with ASD and good language ability, we asked clinicians to monitor reactions to device placement. The clinicians reported “no issues” on either the tactile or noise sensitivity fronts. If there are concerns, a sound field system might be a better starting point