In October, the hearing aid brand Phonak hosted a two-day workshop featuring ten leading clinicians and researchers in the fields of autism, hearing and speech sciences, psychology, and education. Among the goals of the workshop was to assess the current body of research addressing listening challenges in children with autism spectrum disorder (ASD) while identifying areas for ongoing research.
Leading this important initiative for Phonak is Dr. Andrea Dunn. We caught up with Dr. Dunn to learn more about this relatively new area of research and what takeaways exist for practicing clinicians.
For those unfamiliar, what is the potential link between children with ASD and hearing difficulties?
AD: Emerging research suggests that many children with autism spectrum disorder (ASD) have listening difficulties (e.g., difficulty perceiving speech in noise) even in absence of peripheral hearing loss.
For example, a study by Ashburner and colleagues reported that auditory filtering was the most common parent-reported deficit in children with ASD on a global sensory processing questionnaire. There was an apparent difference between the ASD and neurotypical peer groups with 96% of the former having scores in the “definitely different” (DD, 75%) and “probably different” (PD,21%) range compared to 4% (DD = 2%, PD = 2%) in neurotypical peers. Notably, they also found a significant relationship between parent-reported auditory filtering deficits and teacher-reported academic achievement, suggesting that unmanaged listening difficulties can deleteriously affect classroom performance.
How did you become interested in this area of research?
AD: I’ve had a longstanding interest in developmental changes in speech perception and complex listening in challenging environments, like classrooms.
As a practicing audiologist, I worked closely with families of children with autism in a clinical setting. Parents often expressed concerns for hearing and attention, despite normal audiograms and objective test results. In recent years, I discovered empirical research reporting disproportionately poorer speech-in-noise ability in children with autism, findings which echoed parent-reported observations. I am eager to participate in furthering research on auditory symptomology in children with autism and exploring management options for addressing listening difficulties.
How does your (new) role at Phonak contribute to advancing research into this area?
AD: My new role at Phonak gives me the opportunity to consult with ASD experts both inside and outside hearing and speech sciences. Among our goals is to better understand the implications of listening difficulties on children with ASD and their families and how audiologists can partner with other professionals to better support them. This helps shed light onto unanswered questions and allows us to address them through ongoing research.
Currently, Phonak is working with audiology collaborators from clinics in Texas, Oklahoma and Australia to better understand the diagnosis and management of functional auditory deficits in children with ASD.
To find out about the US clinics, or for more information on complex listening abilities of children with autism, please visit www.autism.phonak.com.
What progress or key findings have been made thus far? …any surprises?
AD: One of the exciting findings is the positive impact of remote microphone technology like Phonak’s Roger Focus on speech perception and listening effort in children and adolescents with ASD. Several studies have reported improved speech perception in noise and parent- and teacher-reported communication at home and in school with device use (Rance et al., 2014; Rance et al., 2017; Schafer et al. 2016; Schafer et al., 2019). Rance and colleagues (2017) also found reduced physiologic stress in children with autism using remote microphone technology during a speech-in-noise task. Children with the best aided speech scores showed the greatest difference in aided versus unaided cortisol concentration over the course of the listening session.
What unique needs do clients on the Autism spectrum have that clinicians should be aware of to ensure a successful appointment?
AD: Each child with ASD is unique and patients can present with dramatically different skills and needs. However, social stories are generally helpful in reducing appointment-associated anxiety and improving the patient experience. These are written or visual guides that familiarize children and families with a facility, provider(s), and appointment activities. For example, a short video clip showing a child completing listening tasks in the clinic space can be useful in preparing patients for success and setting them at ease.
Are there proactive steps clinics can take to support families of children with ASD to ensure best outcomes during and after the initial appointment?
AD: Questionnaires assessing auditory milestones and functional auditory abilities can be valuable tools to more fully understand patient skills and needs. Using these to augment a comprehensive case history can be important for understanding real-world auditory functioning and the potential impact of intervention(s).
What resources and research might you suggest for clinicians interested in learning more?
AD: Additional information is available on our website, autism.phonak.com, including citations for several articles and abstracts from journals such as The Journal of Communication Disorders, The American Journal of Occupational Therapy, and The Journal of Pediatrics.
About Andrea Hillock Dunn
Andrea Hillock Dunn, Au.D., Ph.D., Pediatric Clinical Development Manager at Phonak US, is a pediatric audiologist and clinical researcher with expertise in developmental changes in listening and speech perception. She received her bachelor’s degree from Syracuse University, clinical doctorate in Audiology from Northwestern University, and doctorate in philosophy from Vanderbilt University before completing post-doctoral training at the University of North Carolina at Chapel Hill. Dr. Dunn has practiced clinically and is experienced in administration and management, teaching, and research. She has authored numerous journal articles and book chapters, and has lectured extensively on developmental changes in speech perception and childhood hearing loss. In her current role at Phonak, Dr. Dunn is advancing a multi-site clinical initiative focused on the comprehensive assessment and management of functional listening deficits in children with Autism Spectrum Disorder (ASD).