Audiometric Profiles in Autism Spectrum Disorders: Does Subclinical Hearing Loss Impact Communication?

Malay translation, adaptation, and validation of the pediatric Khalfa Hyperacusis Questionnaire for children with autism spectrum disorder

OBJECTIVE

Hyperacusis is characterized by an intolerance to loud sounds, causing discomfort, fear, and facial pain. Its evaluation often includes self-report questionnaires. A recent study in 2023 introduced the pediatric parent-report version of the Khalfa Hyperacusis Questionnaire (P-HQ) for children with autism spectrum disorder (ASD), but no Malay version currently exists, creating a barrier for non-English-speaking parents in Malaysia. This study aimed to translate, culturally adapt, and validate the P-HQ into Malay to improve the understanding of hyperacusis among Malay-speaking populations.

MATERIALS AND METHODS

The study consisted of six stages: (1) forward and backward translation by five independent translators, (2) content validation by six experts, (3) face validity assessments (n = 11), (4) assessment of internal consistency (n = 54), (5) validation of test-retest reliability (n = 23), and (6) assessment of concurrent validity (n = 54) with parents of children with ASD. Participants were purposively recruited from a community autism center located on the east coast of Malaysia.

RESULTS

The translation process was successful, with experts confirming high relevance and agreement (item-level content validity index = 1.0, modified kappa = 1.0). One item was removed due to low item impact, resulting in a 10-item Malay version of the P-HQ (M-P-HQ). The M-P-HQ demonstrated good internal consistency (Cronbach's alpha = 0.884) and moderate to excellent test-retest reliability, with the intraclass correlation coefficient ranging from 0.62 to 0.96. A strong negative Spearman's rank correlation (rs = -0.648) with the auditory filtering subtest of the Malay version of the Short Sensory Profile supported the concurrent validity of the M-P-HQ.

CONCLUSION

The M-P-HQ is a valid, reliable, and culturally appropriate tool for assessing hyperacusis among Malay-speaking parents of children with ASD.

Evaluation of Hearing Thresholds in Infants With Autism Spectrum Disorder Using Auditory Brainstem and Steady-State Responses

Introduction In recent years, most studies on the hearing abilities of children with autism spectrum disorder (ASD) have used the auditory brainstem response (ABR) test alongside other audiological assessments, while only a few have explored the auditory steady-state response (ASSR) test. Moreover, these two electrophysiological methods have not yet been directly compared in this population. This study aims to compare click ABR and chirp ASSR in children with ASD and speech delays to determine whether differences in hearing thresholds can be identified. Methods Children with ASD and speech delays referred to Karamandaneio Children's Hospital between December 13, 2019, and December 6, 2023, were retrospectively identified as cases. Children diagnosed with speech delays but without ASD, who were referred to the same hospital during the same period, were included as controls. Results This study evaluated 30 children (21 males and nine females, totaling 60 ears). Of these, 20 children had been diagnosed with both ASD and speech delay, while 10 were non-ASD children with speech delay and normal hearing, serving as the control group. The participants were aged 19-68 months (median age = 38.5). All ears that responded to the click ABR also responded to each chirp frequency tested by the ASSR. This finding highlights the additional information provided by the ASSR compared to the ABR for threshold estimation, as no instances were observed where a response was obtained for the ABR stimulus but not the ASSR. Click ABR thresholds showed a statistically significant association with chirp ASSR threshold averages at 1,000, 2,000, and 4,000 Hz (rho = 0.316, p = 0.014), as well as at 2,000 and 4,000 Hz (rho = 0.277, p = 0.032). The strongest positive correlation was observed between the two chirp ASSR threshold averages (rho = 0.971, p < 0.001). Conclusions The results suggest that participants diagnosed with ASD exhibit statistically significantly lower mean scores for both click ABR and chirp ASSR threshold averages, with the effect being slightly more pronounced for the chirp ASSR thresholds than for the click ABR.

Prevalence and Profiles of Late-Onset Hearing Loss in Preschool Children with Autism Spectrum Disorder Who Passed Newborn Hearing Screening in a South East Asian Population

Prevalence of hearing loss in children with autism spectrum disorder (ASD) is uncertain, as it is more challenging to assess hearing function in children with developmental difficulties (DD). We aimed to determine the prevalence and profiles of hearing loss in preschool children with ASD in a Southeast-Asian population who passed newborn hearing screening. A retrospective study of preschool children with DD (ASD, Global Developmental Delay (GDD), and Speech and Language Delay (SLD)) attending the Child Development Unit (CDU) at our hospital was performed. Three hundred and thirty-three children (ASD: n = 129; GDD: n = 110; and SLD: n = 94) underwent hearing assessments. Of these, 10.8% of children (n = 36, comprising 15 with ASD, 12 with GDD and 9 with SLD) had confirmed hearing loss. Hearing loss was predominantly bilateral in children with ASD and GDD; in those with SLD, unilateral and bilateral hearing loss were equally common. Conductive hearing loss occurred as frequently as sensorineural hearing loss in children with ASD and SLD, but was the dominant subtype in those with GDD. Moderate to severe hearing loss (n = 2) was noted only in children with ASD. Children with ASD and GDD required significantly more audiology visits and procedures to obtain conclusive hearing test results, compared to those with SLD. The need to identify hearing loss and monitor for resolution is particularly important in vulnerable populations with communication deficits, such as in those with ASD.

Differences between autistic and non-autistic individuals in audiovisual speech integration: A systematic review and meta-analysis

Research has indicated unique challenges in audiovisual integration of speech among autistic individuals, although methodological differences have led to divergent findings. We conducted a systematic literature search to identify studies that measured audiovisual speech integration among both autistic and non-autistic individuals. Across the 18 identified studies (combined N = 952), autistic individuals showed impaired audiovisual integration compared to their non-autistic peers (g = 0.69, 95 % CI [0.53, 0.85], p <.001). This difference was not found to be influenced by participants' mean ages, studies' sample sizes, risk-of-bias scores, or paradigms employed. However, a subgroup analysis suggested that child studies may show larger between-group differences than adult ones. The prevailing pattern of impaired audiovisual speech integration in autism may have cascading effects on communicative and social behavior. However, small samples and inconsistency in designs/analyses translated into considerable heterogeneity in findings and opacity regarding the influence of underlying unisensory and attentional factors. We recommend three key directions for future research: larger samples, more research with adults, and standardization of methodology and analytical approaches.

Global MEG Resting State Functional Connectivity in Children with Autism and Sensory Processing Dysfunction

Sensory processing dysfunction not only affects most individuals with autism spectrum disorder (ASD), but at least 5% of children without ASD also experience dysfunctional sensory processing. Our understanding of the relationship between sensory dysfunction and resting state brain activity is still emerging. This study compared long-range resting state functional connectivity of neural oscillatory behavior in children aged 8-12 years with autism spectrum disorder (ASD; N=18), those with sensory processing dysfunction (SPD; N=18) who do not meet ASD criteria, and typically developing control participants (TDC; N=24) using magnetoencephalography (MEG). Functional connectivity analyses were performed in the alpha and beta frequency bands, which are known to be implicated in sensory information processing. Group differences in functional connectivity and associations between sensory abilities and functional connectivity were examined. Distinct patterns of functional connectivity differences between ASD and SPD groups were found only in the beta band, but not in the alpha band. In both alpha and beta bands, ASD and SPD cohorts differed from the TDC cohort. Somatosensory cortical beta-band functional connectivity was associated with tactile processing abilities, while higher-order auditory cortical alpha-band functional connectivity was associated with auditory processing abilities. These findings demonstrate distinct long-range neural synchrony alterations in SPD and ASD that are associated with sensory processing abilities. Neural synchrony measures could serve as potential sensitive biomarkers for ASD and SPD.

Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions

Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.

Natural language acquisition and gestalt language processing: A critical analysis of their application to autism and speech language therapy. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2024;9:23969415241249944. [PMID: 38784430 PMCID: PMC11113044 DOI: 10.1177/23969415241249944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background and Aim

Recently, there has been a lot of interest surrounding the term gestalt language processor (GLP) which is associated with Natural Language Acquisition (NLA): a protocol intended to support the language development of autistic people. In NLA, delayed echolalia is presumed raw source material that GLPs use to acquire language in a stage-like progression from delayed echolalia to spontaneous speech. The aim of this article is to evaluate NLA in light of relevant literatures to allow scrutiny of NLA claims.

Main contributions

First, we review the notion of gestalt language and situate it in the broader literature on language styles to update understanding of its significance. We then review the links from gestalt language processing to autism and identify definitional and conceptual problems and clarify the construct 'episodic memory'. We discuss the 'raw material view of delayed echolalia' and identify theoretical and empirical shortcomings. Finally, we review Blanc's language stages and their accompanying assessment and language support recommendations and challenge their validity.

Conclusions & Implications

The term 'gestalt language processor' is definitionally and conceptually troubled, the assertion that autistic people are GLPs is misleading and unhelpful, and evidence is lacking that GLP represents a legitimate clinical entity. The theoretical basis of NLA lacks empirical support. NLA stages are implausible and their accompanying assessment and support recommendations lack justification. We recommend the use of alternate, individualized, theoretically-sound, evidence-based, neurodiversity-affirming supports that are sensitive and responsive to the heterogeneity that defines autism.

Assessing Autism in Deaf/Hard-of-Hearing Youths: Interdisciplinary Teams, COVID Considerations, and Future Directions

Autism spectrum disorders are more prevalent in children who are Deaf or Hard of Hearing (D/HH) than in the general population. This potential for diagnostic overlap underscores the importance of understanding the best approaches for assessing autism spectrum disorder in D/HH youths. Despite the recognition of clinical significance, youths who are D/HH are often identified as autistic later than individuals with normal hearing, which results in delayed access to appropriate early intervention services. Three primary barriers to early identification include behavioral phenotypic overlap, a lack of "gold-standard" screening and diagnostic tools for this population, and limited access to qualified clinicians. In the current article, we seek to address these barriers to prompt an appropriate identification of autism by providing recommendations for autism assessment in children who are D/HH from an interdisciplinary hearing and development clinic, including virtual service delivery during COVID-19. Strengths, gaps, and future directions for implementation are addressed.

Habituation of auditory responses in young autistic and neurotypical children

Prior studies suggest that habituation of sensory responses is reduced in autism and that diminished habituation could be related to atypical autistic sensory experiences, for example, by causing brain responses to aversive stimuli to remain strong over time instead of being suppressed. While many prior studies exploring habituation in autism have repeatedly presented identical stimuli, other studies suggest group differences can still be observed in habituation to intermittent stimuli. The present study explored habituation of electrophysiological responses to auditory complex tones of varying intensities (50-80 dB SPL), presented passively in an interleaved manner, in a well-characterized sample of 127 autistic (MDQ  = 65.41, SD = 20.54) and 79 typically developing (MDQ  = 106.02, SD = 11.50) children between 2 and 5 years old. Habituation was quantified as changes in the amplitudes of single-trial responses to tones of each intensity over the course of the experiment. Habituation of the auditory N2 response was substantially reduced in autistic participants as compared to typically developing controls, although diagnostic groups did not clearly differ in habituation of the P1 response. Interestingly, the P1 habituated less to loud 80 dB sounds than softer sounds, whereas the N2 habituated less to soft 50 dB sounds than louder sounds. No associations were found between electrophysiological habituation and cognitive ability or participants' caregiver-reported sound tolerance (Sensory Profile Hyperacusis Index). The results present study results extend prior research suggesting habituation of certain sensory responses is reduced in autism; however, they also suggest that habituation differences observed using this study's paradigm might not be a primary driver of autistic participants' real-world sound intolerance.

Associations between rapid auditory processing of speech sounds and specific verbal communication skills in autism

Introduction

The ability to rapidly process speech sounds is integral not only for processing other's speech, but also for auditory processing of one's own speech, which allows for maintenance of speech accuracy. Deficits in rapid auditory processing have been demonstrated in autistic individuals, particularly those with language impairment. We examined rapid auditory processing for speech sounds in relation to performance on a battery of verbal communication measures to determine which aspects of verbal communication were associated with cortical auditory processing in a sample of individuals with autism.

Methods

Participants were 57 children and adolescents (40 male and 17 female) ages 5-18 who were diagnosed with an Autism Spectrum Disorder (ASD). Rapid auditory processing of speech sounds was measured via a magnetoencephalographic (MEG) index of the quality of the auditory evoked response to the second of two differing speech sounds ("Ga" / "Da") presented in rapid succession. Verbal communication abilities were assessed on standardized clinical measures of overall expressive and receptive language, vocabulary, articulation, and phonological processing. Associations between cortical measures of left- and right-hemisphere rapid auditory processing and verbal communication measures were examined.

Results

Rapid auditory processing of speech sounds was significantly associated with speech articulation bilaterally (r = 0.463, p = 0.001 for left hemisphere and r = 0.328, p = 0.020 for right hemisphere). In addition, rapid auditory processing in the left hemisphere was significantly associated with overall expressive language abilities (r = 0.354, p = 0.013); expressive (r = 0.384, p = 0.005) vocabulary; and phonological memory (r = 0.325, p = 0.024). Phonological memory was found to mediate the relationship between rapid cortical processing and receptive language.

Discussion

These results demonstrate that impaired rapid auditory processing for speech sounds is associated with dysfunction in verbal communication in ASD. The data also indicate that intact rapid auditory processing may be necessary for even basic communication skills that support speech production, such as phonological memory and articulatory control.

Qualitative and quantitative analysis of self-care regarding sensory issues among people with neurodevelopmental disorders

Introduction

Issues in sensory processing (hereafter, sensory issues) associated with neurodevelopmental disorders are known to be particularly prominent from 6 to 9 years of age and are a critical issue in school life. These issues affect each individual's quality of life. Some of the issues are known to be relieved by self-care while some are not.

Methods

To clarify the sensory issues that cannot be managed by self-care, this study examined self-care for sensory issues among people with neurodevelopmental disorders using a web survey. The survey encompassed questions about neurodevelopmental disorders, the sensory issues individuals experience, and the kind of self-care they perform. In the qualitative analysis, each was categorized by the type of sensory modality; we further scrutinized the descriptions of self-care, which were collected simultaneously, and examined how each problem was addressed.

Results

Self-care was categorized as "physically blocking," "leaving from," "relaxing," "devising," "help from others," "taking medication," "coping with body," "others," or "could not cope." Based on these findings, we quantitatively compared the frequency of sensory issues that could and could not be managed by self-care. Consequently, significantly higher percentages of the participants stated that they experienced difficulties in managing problems about "body representations," "contact with humans," "selective listening," and "force control." In contrast, significantly more participants stated that they could manage problems related to "loud sound" and "dazzling".

Conclusion

In this study, qualitative analysis allowed us to categorize methods of self-care for sensory issues, and quantitative research allowed us to identify issues that were difficult to manage. While it was possible to manage strong light and sound using sunglasses, earplugs, and so on, problems related to the senses of proprioception, selective attention, and so on were clearly difficult to manage.

Oromotor skills in autism spectrum disorder: A scoping review

Oromotor functioning plays a foundational role in spoken communication and feeding, two areas of significant difficulty for many autistic individuals. However, despite years of research and established differences in gross and fine motor skills in this population, there is currently no clear consensus regarding the presence or nature of oral motor control deficits in autistic individuals. In this scoping review, we summarize research published between 1994 and 2022 to answer the following research questions: (1) What methods have been used to investigate oromotor functioning in autistic individuals? (2) Which oromotor behaviors have been investigated in this population? and (3) What conclusions can be drawn regarding oromotor skills in this population? Seven online databases were searched resulting in 107 studies meeting our inclusion criteria. Included studies varied widely in sample characteristics, behaviors analyzed, and research methodology. The large majority (81%) of included studies report a significant oromotor abnormality related to speech production, nonspeech oromotor skills, or feeding within a sample of autistic individuals based on age norms or in comparison to a control group. We examine these findings to identify trends, address methodological aspects hindering cross-study synthesis and generalization, and provide suggestions for future research.

Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the Avon Longitudinal Study of Parents and Children (ALSPAC) geographically defined childhood population

OBJECTIVE

To determine whether early ear and upper respiratory signs are associated with the development of high levels of autistic traits or diagnosed autism.

DESIGN

Longitudinal birth cohort: Avon Longitudinal Study of Parents and Children (ALSPAC).

SETTING

Area centred on the city of Bristol in Southwest England. Eligible pregnant women resident in the area with expected date of delivery between April 1991 and December 1992 inclusive.

PARTICIPANTS

10 000+ young children followed throughout their first 4 years. Their mothers completed three questionnaires between 18-42 months recording the frequency of nine different signs and symptoms relating to the upper respiratory system, as well as ear and hearing problems.

OUTCOME MEASURES

Primary-high levels of autism traits (social communication, coherent speech, sociability, and repetitive behaviour); secondary-diagnosed autism.

RESULTS

Early evidence of mouth breathing, snoring, pulling/poking ears, ears going red, hearing worse during a cold, and rarely listening were associated with high scores on each autism trait and with a diagnosis of autism. There was also evidence of associations of pus or sticky mucus discharge from ears, especially with autism and with poor coherent speech. Adjustment for 10 environmental characteristics made little difference to the results, and substantially more adjusted associations were at p<0.001 than expected by chance (41 observed; 0.01 expected). For example, for discharge of pus or sticky mucus from ears the adjusted odds ratio (aOR) for autism at 30 months was 3.29 (95% CI 1.85 to 5.86, p<0.001), and for impaired hearing during a cold the aOR was 2.18 (95% CI 1.43 to 3.31, p<0.001).

CONCLUSIONS

Very young children exhibiting common ear and upper respiratory signs appear to have an increased risk of a subsequent diagnosis of autism or demonstrated high levels of autism traits. Results suggest the need for identification and management of ear, nose and throat conditions in autistic children and may provide possible indicators of causal mechanisms.

Sensory profiles, behavioral problems, and auditory findings in children with autism spectrum disorder

Objective

This study examined the relationship between sensory processing (SP) differences and behavioral problems in children with autism spectrum disorder (ASD). We also investigated whether audiological test results could objectively detect auditory processing differences.

Method

Forty-six children with ASD, ages 3-9 years, were enrolled in the study. Problematic behaviors and sensory processing of children were assessed using scales. The otolaryngologist performed a detailed head and neck examination and a formal audiological examination was performed by an audiologist.

Results

Stereotypy, hyperactivity, and irritability were related to sensation seeking. Stereotypy was also associated with visual processing. Touch processing differences was related to irritability and inappropriate speech. Lethargy was associated with auditory processing. There were no differences in SP and behavior problems in the children whose audiological profiles could be measured between those who passed or failed the test.

Conclusion

There was an association between SP differences and behavioral problems in children with ASD, supporting previous studies. Audiological test results did not reveal the SP differences documented in the parent forms.

Auditory Brainstem Response in Autistic Children: Implications for Sensory Processing

Purpose

Autistic individuals frequently experience sensory processing difficulties. Such difficulties can significantly impact important functions and quality of life. We are only beginning to understand the neural mechanisms of atypical sensory processing. However, one established way to measure aspects of auditory function is the auditory brainstem response (ABR). While ABR has been primarily hypothesized thus far as a means of early detection/diagnosis in autism, it has the potential to aid in examining sensory processing in this population.

Method

Thus, we investigated standard ABR waveform characteristics in age-matched groups of autistic and typically developing children during various stimulus and intensity conditions. We also examined within ear waveform cross correlations and inter-aural cross correlations (IACC) to assess replicability and synchrony of participants' ABRs, which was a novel approach to ABR analysis in this population.

Results

We observed longer peak latencies (esp. wave III and V) and interpeak latencies in the autism and typically developing groups in different conditions. There were no statistically significant results in cross correlation or IACC.

Conclusions

These results suggest that brainstem auditory function may differ slightly, but is mostly similar, between autistic and typically developing children. We discuss these findings in terms of their implications for sensory processing and future utility.

Rapid auditory processing of puretones is associated with basic components of language in individuals with autism spectrum disorders

The goal of this study was to identify the specific domains of language that may be affected by deficits in rapid auditory processing in individuals with ASD. Auditory evoked fields were collected from 63 children diagnosed with ASD in order to evaluate processing of puretone sounds presented in rapid succession. Measures of language and its components were assessed via standardized clinical tools to quantify expressive and receptive language, vocabulary, articulation, and phonological processing abilities. Rapid processing was significantly and bilaterally associated with phonological awareness, vocabulary, and articulation. Phonological processing was found to mediate the relationship between rapid processing and language. M100 response latency was not significantly associated with any language measures. Results suggest that rapid processing deficits may impact the basic components of language such as phonological processing, and the downstream effect of this impact may in turn impact overall language development.

Musical preferences of Indian children with autism spectrum disorder and acceptability of music therapy by their families: An exploratory study

Background

Music therapy has been in use for children with autism spectrum disorder (ASD) since the 1940s. However, there is limited scientific evidence on its use in the Indian context.

Aim

The present study aims to explore musical preferences of children with ASD and their caregivers' acceptability of music as a form of intervention.

Materials and Methods

It is a cross-sectional study of 120 subjects diagnosed with ASD as per the Diagnostic and Statistical Manual of Mental Disorders-5 identified by convenience sampling. A semi-structured interview schedule consisting of 25 objective response questions with multiple choices and 11 open-ended questions (pertaining to music and the use of music) was used to explore caregivers'/parents' thoughts and beliefs. The responses to open-ended questions were collected in narrative mode. A descriptive approach of content analysis was adopted to analyse the data. The data are presented using descriptive statistics. Institutional Ethics Committee's approval was obtained for conducting the study.

Results

Most of the children liked (89.2%, n = 107) music and responded (88.3%, n = 106) actively (listen intently/hum or sing or dance along) to music. Most subjects preferred rhythm (65%, n = 78) over melody (15%, n = 18). While 98.3% (n = 118) of the parents were willing to try music therapy for their child, 61% of them (n = 72) asked follow-up questions like - "Is there available data on it?" (n = 12; 10.2%) and "Will it be worth investing our time and efforts on it?" (n = 60; 50.8%).

Conclusion

Most of the children including those with auditory sensitivity like music and prefer rhythm over melody. Caregivers possess a positive attitude toward the use of music therapy. However, most of them wish to clarify the scientific basis of the same.

Appraising the need for audiological assessment before autism spectrum disorder referral

Objectives

Mandatory audiological testing before autism spectrum disorder (ASD) assessment is common practice. Hearing impairment (HI) in the general paediatric population is estimated at 3%; however, hearing impairment prevalence among children with ASD is poorly established. Our objective was to determine which children referred for ASD assessment require preliminary audiological assessment.

Methods

Retrospective chart review of children (n=4,173; 0 to 19 years) referred to British Columbia's Autism Assessment Network (2010 to 2014). We analyzed HI rate, risk factors, and timing of HI diagnosis relative to ASD referral.

Results

ASD was diagnosed in 53.4%. HI rates among ASD referrals was 3.3% and not significantly higher in children with ASD (ASD+; 3.5%) versus No-ASD (3.0%). No significant differences in HI severity or type were found, but more ASD+ females (5.5%) than ASD+ males (3.1%) had HI (P<0.05). Six HI risk factors were significant (problems with intellect, language, vision/eye, ear, genetic abnormalities, and prematurity) and HI was associated with more risk factors (P<0.01). Only 12 children (8.9%) were diagnosed with HI after ASD referral; all males 6 years or younger and only one had no risk factors. ASD+ children with HI were older at ASD referral than No-ASD (P<0.05).

Conclusions

Children with ASD have similar hearing impairment rates to those without ASD. HI may delay referral for ASD assessment. As most children were diagnosed with HI before ASD referral or had at least one risk factor, we suggest that routine testing for HI among ASD referrals should only be required for children with risk factors.

A Multidimensional Investigation of Sensory Processing in Autism: Parent- and Self-Report Questionnaires, Psychophysical Thresholds, and Event-Related Potentials in the Auditory and Somatosensory Modalities

Background

Reconciling results obtained using different types of sensory measures is a challenge for autism sensory research. The present study used questionnaire, psychophysical, and neurophysiological measures to characterize autistic sensory processing in different measurement modalities.

Methods

Participants were 46 autistic and 21 typically developing 11- to 14-year-olds. Participants and their caregivers completed questionnaires regarding sensory experiences and behaviors. Auditory and somatosensory event-related potentials (ERPs) were recorded as part of a multisensory ERP task. Auditory detection, tactile static detection, and tactile spatial resolution psychophysical thresholds were measured.

Results

Sensory questionnaires strongly differentiated between autistic and typically developing individuals, while little evidence of group differences was observed in psychophysical thresholds. Crucially, the different types of measures (neurophysiological, psychophysical, questionnaire) appeared to be largely independent of one another. However, we unexpectedly found autistic participants with larger auditory Tb ERP amplitudes had reduced hearing acuity, even though all participants had hearing acuity in the non-clinical range.

Limitations

The autistic and typically developing groups were not matched on cognitive ability, although this limitation does not affect our main analyses regarding convergence of measures within autism.

Conclusion

Overall, based on these results, measures in different sensory modalities appear to capture distinct aspects of sensory processing in autism, with relatively limited convergence between questionnaires and laboratory-based tasks. Generally, this might reflect the reality that laboratory tasks are often carried out in controlled environments without background stimuli to compete for attention, a context which may not closely resemble the busier and more complex environments in which autistic people's atypical sensory experiences commonly occur. Sensory questionnaires and more naturalistic laboratory tasks may be better suited to explore autistic people's real-world sensory challenges. Further research is needed to replicate and investigate the drivers of the unexpected association we observed between auditory Tb ERP amplitudes and hearing acuity, which could represent an important confound for ERP researchers to consider in their studies.

Atypical Auditory Perception Caused by Environmental Stimuli in Autism Spectrum Disorder: A Systematic Approach to the Evaluation of Self-Reports

Recent studies have revealed that atypical sensory perception is common in individuals with autism spectrum disorder (ASD) and is considered a potential cause of social difficulties. Self-reports by individuals with ASD have provided great insights into atypical perception from the first-person point of view and indicated its dependence on the environment. This study aimed to investigate the patterns and environmental causes of atypical auditory perception in individuals with ASD. Qualitative data from subject reports are inappropriate for statistical analysis, and reporting subjective sensory experiences is not easy for every individual. To cope with such challenges, we employed audio signal processing methods to simulate the potential patterns of atypical auditory perception. The participants in our experiment were able to select and adjust the strength of the processing methods to manipulate the sounds in the videos to match their experiences. Thus, the strength of atypical perception was recorded quantitatively and then analyzed to assess its correlation with the audio-visual stimuli contained in the videos the participants observed. In total, 22 participants with ASD and 22 typically developed (TD) participants were recruited for the experiment. The results revealed several common patterns of atypical auditory perception: Louder sounds perceived in a quiet environment, noise perception induced by intense and unsteady audio-visual stimuli, and echo perception correlated with movement and variation in sound level. The ASD group reported atypical perceptions more frequently than the control group. However, similar environmental causes were shared by the ASD and TD groups. The results help us infer the potential neural and physiological mechanisms of sensory processing in ASD.

Functional Connectivity-Based Prediction of Autism on Site Harmonized ABIDE Dataset

OBJECTIVE

The larger sample sizes available from multi-site publicly available neuroimaging data repositories makes machine-learning based diagnostic classification of mental disorders more feasible by alleviating the curse of dimensionality. However, since multi-site data are aggregated post-hoc, i.e. they were acquired from different scanners with different acquisition parameters, non-neural inter-site variability may mask inter-group differences that are at least in part neural in origin. Hence, the advantages gained by the larger sample size in the context of machine-learning based diagnostic classification may not be realized.

METHODS

We address this issue using harmonization of multi-site neuroimaging data using the ComBat technique, which is based on an empirical Bayes formulation to remove inter-site differences in data distributions, to improve diagnostic classification accuracy. Specifically, we demonstrate this using ABIDE (Autism Brain Imaging Data Exchange) multi-site data for classifying individuals with Autism from healthy controls using resting state fMRI-based functional connectivity data.

RESULTS

Our results show that higher classification accuracies across multiple classification models can be obtained (especially for models based on artificial neural networks) from multi-site data post harmonization with the ComBat technique as compared to without harmonization, outperforming earlier results from existing studies using ABIDE. Furthermore, our network ablation analysis facilitated important insights into autism spectrum disorder pathology and the connectivity in networks shown to be important for classification covaried with verbal communication impairments in Autism.

CONCLUSION

Multi-site data harmonization using ComBat improves neuroimaging-based diagnostic classification of mental disorders.

SIGNIFICANCE

ComBat has the potential to make AI-based clinical decision-support systems more feasible in psychiatry.

Auditory hypersensitivity and processing deficits in a rat model of fragile X syndrome

Fragile X (FX) syndrome is one of the leading inherited causes of autism spectrum disorder (ASD). A majority of FX and ASD patients exhibit sensory hypersensitivity, including auditory hypersensitivity or hyperacusis, a condition in which everyday sounds are perceived as much louder than normal. Auditory processing deficits in FX and ASD also afford the opportunity to develop objective and quantifiable outcome measures that are likely to translate between humans and animal models due to the well-conserved nature of the auditory system and well-developed behavioral read-outs of sound perception. Therefore, in this study we characterized auditory hypersensitivity in a Fmr1 knockout (KO) transgenic rat model of FX using an operant conditioning task to assess sound detection thresholds and suprathreshold auditory reaction time-intensity (RT-I) functions, a reliable psychoacoustic measure of loudness growth, at a variety of stimulus frequencies, bandwidths, and durations. Male Fmr1 KO and littermate WT rats both learned the task at the same rate and exhibited normal hearing thresholds. However, Fmr1 KO rats had faster auditory RTs over a broad range of intensities and steeper RT-I slopes than WT controls, perceptual evidence of excessive loudness growth in Fmr1 KO rats. Furthermore, we found that Fmr1 KO animals exhibited abnormal perceptual integration of sound duration and bandwidth, with diminished temporal but enhanced spectral integration of sound intensity. Because temporal and spectral integration of sound stimuli were altered in opposite directions in Fmr1 KO rats, this suggests that abnormal RTs in these animals are evidence of aberrant auditory processing rather than generalized hyperactivity or altered motor responses. Together, these results are indicative of fundamental changes to low-level auditory processing in Fmr1 KO animals. Finally, we demonstrated that antagonism of metabotropic glutamate receptor 5 (mGlu5) selectively and dose-dependently restored normal loudness growth in Fmr1 KO rats, suggesting a pharmacologic approach for alleviating sensory hypersensitivity associated with FX. This study leverages the tractable nature of the auditory system and the unique behavioral advantages of rats to provide important insights into the nature of a centrally important yet understudied aspect of FX and ASD.

Characteristic Deviations of Auditory Evoked Potentials in Individuals with Autism Spectrum Disorder

BACKGROUND

Neurological, structural, and behavioral abnormalities are widely reported in individuals with autism spectrum disorder (ASD); yet there are no objective markers to date. We postulated that by using dominant and nondominant ear data, underlying differences in auditory evoked potentials (AEPs) between ASD and control groups can be recognized.

PURPOSE

The primary purpose was to identify if significant differences exist in AEPs recorded from dominant and nondominant ear stimulation in (1) children with ASD and their matched controls, (2) adults with ASD and their matched controls, and (3) a combined child and adult ASD group and control group. The secondary purpose was to explore the association between the significant findings of this study with those obtained in our previous study that evaluated the effects of auditory training on AEPs in individuals with ASD.

RESEARCH DESIGN

Factorial analysis of variance with interaction was performed.

STUDY SAMPLE

Forty subjects with normal hearing between the ages of 9 and 25 years were included. Eleven children and 9 adults with ASD were age- and gender-matched with neurotypical peers.

DATA COLLECTION AND ANALYSIS

Auditory brainstem responses (ABRs) and auditory late responses (ALRs) were recorded. Adult and child ASD subjects were compared with non-ASD adult and child control subjects, respectively. The combined child and adult ASD group was compared with the combined child and adult control group.

RESULTS

No significant differences in ABR latency or amplitude were observed between ASD and control groups. ALR N1 amplitude in the dominant ear was significantly smaller for the ASD adult group compared with their control group. Combined child and adult data showed significantly smaller amplitude for ALR N1 and longer ALR P2 latency in the dominant ear for the ASD group compared with the control group. In our earlier study, the top predictor of behavioral improvement following auditory training was ALR N1 amplitude in the dominant ear. Correspondingly, the ALR N1 amplitude in the dominant ear yielded group differences in the current study.

CONCLUSIONS

ALR peak N1 amplitude is proposed as the most feasible AEP marker in the evaluation of ASD.

Prevalence of Decreased Sound Tolerance (Hyperacusis) in Individuals With Autism Spectrum Disorder: A Meta-Analysis

OBJECTIVES

Hyperacusis, defined as decreased tolerance to sound at levels that would not trouble most individuals, is frequently observed in individuals with autism spectrum disorder (ASD). Despite the functional impairment attributable to hyperacusis, little is known about its prevalence or natural history in the ASD population. The objective of this study was to conduct a systematic review and meta-analysis estimating the current and lifetime prevalence of hyperacusis in children, adolescents, and adults with ASD. By precisely estimating the burden of hyperacusis in the ASD population, the present study aims to enhance recognition of this particular symptom of ASD and highlight the need for additional research into the causes, prevention, and treatment of hyperacusis in persons on the spectrum.

DESIGN

We searched PubMed and ProQuest to identify peer-reviewed articles published in English after January 1993. We additionally performed targeted searches of Google Scholar and the gray literature, including studies published through May 2020. Eligible studies included at least 20 individuals with diagnosed ASD of any age and reported data from which the proportion of ASD individuals with current and/or lifetime hyperacusis could be derived. To account for multiple prevalence estimates derived from the same samples, we utilized three-level Bayesian random-effects meta-analyses to estimate the current and lifetime prevalence of hyperacusis. Bayesian meta-regression was used to assess potential moderators of current hyperacusis prevalence. To reduce heterogeneity due to varying definitions of hyperacusis, we performed a sensitivity analysis on the subset of studies that ascertained hyperacusis status using the Autism Diagnostic Interview-Revised (ADI-R), a structured parent interview.

RESULTS

A total of 7783 nonduplicate articles were screened, of which 67 were included in the review and synthesis. Hyperacusis status was ascertained in multiple ways across studies, with 60 articles employing interviews or questionnaires and seven using behavioral observations or objective measures. The mean (range) age of samples in the included studies was 7.88 years (1.00 to 34.89 years). The meta-analysis of interview/questionnaire measures (k(3) = 103, nASD = 13,093) estimated the current and lifetime prevalence of hyperacusis in ASD to be 41.42% (95% CrI, 37.23 to 45.84%) and 60.58% (50.37 to 69.76%), respectively. A sensitivity analysis restricted to prevalence estimates derived from the ADI-R (k(3) = 25, nASD = 5028) produced similar values. The estimate of current hyperacusis prevalence using objective/observational measures (k(3) = 8, nASD = 488) was 27.30% (14.92 to 46.31%). Heterogeneity in the full sample of interview/questionnaire measures was substantial but not significantly explained by any tested moderator. However, prevalence increased sharply with increasing age in studies using the ADI-R (BF10 = 93.10, R2Het = 0.692).

CONCLUSIONS

In this meta-analysis, we found a high prevalence of current and lifetime hyperacusis in individuals with ASD, with a majority of individuals on the autism spectrum experiencing hyperacusis at some point in their lives. The high prevalence of hyperacusis in individuals with ASD across the lifespan highlights the need for further research on sound tolerance in this population and the development of services and/or interventions to reduce the burden of this common symptom.

Hyperacusis in Autism Spectrum Disorders

Hyperacusis is highly prevalent in the autism spectrum disorder (ASD) population. This auditory hypersensitivity can trigger pragmatically atypical reactions that may impact social and academic domains. Objective: The aim of this report is to describe the relationship between decreased sound tolerance disorders and the ASD population. Topics covered: The main topics discussed include (1) assessment and prevalence of hyperacusis in ASD; (2) etiology of hyperacusis in ASD; (3) treatment of hyperacusis in ASD. Conclusions: Knowledge of the assessment and treatment of decreased sound tolerance disorders within the ASD population is growing and changing.

Central Auditory and Vestibular Dysfunction Are Key Features of Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by repetitive behaviors, poor social skills, and difficulties with communication. Beyond these core signs and symptoms, the majority of subjects with ASD have some degree of auditory and vestibular dysfunction. Dysfunction in these sensory modalities is significant as normal cognitive development depends on an accurate representation of our environment. The hearing difficulties in ASD range from deafness to hypersensitivity and subjects with ASD have abnormal sound-evoked brainstem reflexes and brainstem auditory evoked potentials. Vestibular dysfunction in ASD includes postural instability, gait dysfunction, and impaired gaze. Untreated vestibular dysfunction in children can lead to delayed milestones such as sitting and walking and poor motor coordination later in life. Histopathological studies have revealed that subjects with ASD have significantly fewer neurons in the auditory hindbrain and surviving neurons are smaller and dysmorphic. These findings are consistent with auditory dysfunction. Further, the cerebellum was one of the first brain structures implicated in ASD and studies have revealed loss of Purkinje cells and the presence of ectopic neurons. Together, these studies suggest that normal auditory and vestibular function play major roles in the development of language and social abilities, and dysfunction in these systems may contribute to the core symptoms of ASD. Further, auditory and vestibular dysfunction in children may be overlooked or attributed to other neurodevelopmental disorders. Herein we review the literature on auditory and vestibular dysfunction in ASD. Based on these results we developed a brainstem model of central auditory and vestibular dysfunction in ASD and propose that simple, non-invasive but quantitative testing of hearing and vestibular function be added to newborn screening protocols.

Audiometric profiles in children with speech sound disorder: Subclinical hearing loss as a potential factor

In the present study, hearing sensitivity in children with speech sound disorder (SSD) is scrutinized. Middle ear function (wideband tympanometry and acoustic stapedial reflexes, ASR) and inner ear function (audiometric thresholds in the conventional_{1-8 kHz} and extended_{10-16 kHz} high frequency (EHF) range, and distortion product otoacoustic emissions (DPOAEs_{2-10 kHz}) were investigated. Hearing results were analyzed in relation to speech discrimination of phonemic contrasts (quiet and in noise conditions) and reproduction. Thirty-two children with SSD and 41 children with typical development (TD) ages 4-5 years participated. Children with SSD exhibited significantly less sensitive hearing compared to children with TD. This was demonstrated as more absent contralateral ASR (right ear SSD 43.7%; TD 22.0%), a higher prevalence of minimal hearing loss (MHL, > 15 dB HL at one or more frequencies or ears_{1-8 kHz} and PTA ≤ 20 dB HL, SSD 53.1%; TD 24.3%) and EHF hearing impairment (EHF HI, > 20 dB HL at one or more frequencies or ears_{10-16 kHz}, SSD 31.3%; TD 24.3%). At 2 kHz bilaterally, children with SSD showed significantly higher hearing thresholds than children with TD (mean difference, left ear 3.4 dB: right ear 4.3 dB), together with a significantly lower SNR in DPOAEs at 2.2 kHz (left ear 5.1 dB mean difference between groups). In all children, audiometric thresholds at the key-frequencies for speech, 2 and 4 kHz and DPOAEs within similar spectral regions, predicted 7-12% of the variance in phonemic discrimination and reproduction. Overall, these results suggest that hearing should be more fully investigated in children with SSD.

Hearing Loss in Neurological Disorders

Sensorineural hearing loss (SNHL) affects approximately 466 million people worldwide, which is projected to reach 900 million by 2050. Its histological characteristics are lesions in cochlear hair cells, supporting cells, and auditory nerve endings. Neurological disorders cover a wide range of diseases affecting the nervous system, including Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), autism spectrum disorder (ASD), etc. Many studies have revealed that neurological disorders manifest with hearing loss, in addition to typical nervous symptoms. The prevalence, manifestations, and neuropathological mechanisms underlying vary among different diseases. In this review, we discuss the relevant literature, from clinical trials to research mice models, to provide an overview of auditory dysfunctions in the most common neurological disorders, particularly those associated with hearing loss, and to explain their underlying pathological and molecular mechanisms.

Using Clustering to Examine Inter-individual Variability in Topography of Auditory Event-Related Potentials in Autism and Typical Development

Although prior studies have compared sensory event-related potential (ERP) responses between groups of autistic and typically-developing participants, it is unclear how heterogeneity contributes to the results of these studies. The present study used examined individual differences in these responses. 130 autistic children and 81 typically-developing children, aged between 2 and 5 years, listened to tones at four identity levels while 61-channel electroencephalography was recorded. Hierarchical clustering was used to group participants based on rescaled ERP topographies between 51 and 350 ms. The hierarchical clustering analysis revealed substantial heterogeneity. Some of the seven clusters defined in this analysis were characterized by prolonged fronto-central positivities and/or weak or absent N2 negativities. However, many other participants fell into clusters in which N2 responses were present at varying latencies. Atypical response morphologies such as absent N2 responses and/or prolonged positive-going responses found in some autistic participants may account for prior research findings of attenuated N2 amplitudes in autism. However, there was also considerable overlap between groups, with participants of both groups appearing in all clusters. These results emphasize the utility of using clustering to explore individual differences in brain responses, which can expand on and clarify the results of analyses of group mean differences.

Auditory brainstem responses in adults with autism spectrum disorder

OBJECTIVE

To investigate possible differences in the auditory peripheral and brainstem functions between adults with autism spectrum disorder (ASD) and neurotypical (NT) adults.

METHODS

Click-evoked auditory brainstem responses (ABRs) were obtained from 17 high-functioning ASD adults (aged 21-38 years) and 20 NT adults (aged 22-36 years). A relatively large number of stimulus presentations (6000) were adopted, and ABRs by horizontal and vertical electrode montages were evaluated, in order to allow precise evaluations of early ABR components.

RESULTS

Waves I, II, III, and V were identified in the vertical electrode montage, and wave I and the summating potential (SP) in electrocochleograms were identified in the horizontal electrode montage. There were no significant group differences in the wave I, II, III, and V latencies or the interpeak latencies (IPLs) in the vertical electrode montage. In the horizontal montage, the ASD adults exhibited significantly shortened SP latencies compared with the NT adults, whereas there was no significant group difference in the wave I latency.

CONCLUSION

The ASD adults may have the abnormalities of processing more in the peripheral auditory system than in the brainstem.

SIGNIFICANCE

The current study suggests that the peripheral abnormality is associated with ASD.

Improving Emotion Perception in Children with Autism Spectrum Disorder with Computer-Based Training and Hearing Amplification

Individuals with Autism Spectrum Disorder (ASD) experience challenges with social communication, often involving emotional elements of language. This may stem from underlying auditory processing difficulties, especially when incoming speech is nuanced or complex. This study explored the effects of auditory training on social perception abilities of children with ASD. The training combined use of a remote-microphone hearing system and computerized emotion perception training. At baseline, children with ASD had poorer social communication scores and delayed mismatch negativity (MMN) compared to typically developing children. Behavioral results, measured pre- and post-intervention, revealed increased social perception scores in children with ASD to the extent that they outperformed their typically developing peers post-intervention. Electrophysiology results revealed changes in neural responses to emotional speech stimuli. Post-intervention, mismatch responses of children with ASD more closely resembled their neurotypical peers, with shorter MMN latencies, a significantly heightened P2 wave, and greater differentiation of emotional stimuli, consistent with their improved behavioral results. This study sets the foundation for further investigation into connections between auditory processing difficulties and social perception and communication for individuals with ASD, and provides a promising indication that combining amplified hearing and computer-based targeted social perception training using emotional speech stimuli may have neuro-rehabilitative benefits.

Effects of age on loudness-dependent auditory ERPs in young autistic and typically-developing children

Limited research has investigated the development of auditory ERPs in young children, and particularly how stimulus intensity may affect these auditory ERPs. Previous research has also yielded inconsistent findings regarding differences in the development of auditory ERPs in autism and typical development. Furthermore, stimulus intensity may be of particular interest in autism insofar as autistic people may have atypical experiences of sound intensity (e.g., hyperacusis). Therefore, the present study examined associations between age and ERPs evoked by tones of differing intensities (50, 60, 70, and 80 dB SPL) in a large sample of young children (2-5 years) with and without an autism diagnosis. Correlations between age and P1 latencies were examined, while cluster-based permutation testing was used to examine associations between age and neural response amplitudes, as well as group differences in amplitude, over all electrode sites in the longer time window of 1-350 ms. Older autistic participants had faster P1 latencies, but these effects only attained significance over the right hemisphere in response to soft 50 dB sounds. Autistic participants had slower P1 responses to 80 dB sounds over the right hemisphere. Over the scalp regions associated with the later N2 response, more negative response amplitudes (that is, larger N2 responses) were observed in typically-developing than autistic participants. Furthermore, continuous associations between response amplitudes and age suggested that older typically-developing participants exhibited stronger N2 responses to all intensities, though this effect may have at least in part reflected the absence of small positive voltage deflections in the N2 latency window. Age was associated with amplitudes of responses to 50 dB through 70 dB sounds in autism, but in contrast to Typical Development (TD), little evidence of relationships between age and amplitudes in the N2 latency window was found in autism in the 80 dB condition. Although caution should be exercised in interpretation due to the cross-sectional nature of this study, these findings suggest that developmental changes in auditory responses may differ across diagnostic groups in a manner that depends on perceived loudness and/or stimulus intensity.

Shorter P1m Response in Children with Autism Spectrum Disorder without Intellectual Disabilities

(1) Background: Atypical auditory perception has been reported in individuals with autism spectrum disorder (ASD). Altered auditory evoked brain responses are also associated with childhood ASD. They are likely to be associated with atypical brain maturation. (2) Methods: This study examined children aged 5–8 years old: 29 with ASD but no intellectual disability and 46 age-matched typically developed (TD) control participants. Using magnetoencephalography (MEG) data obtained while participants listened passively to sinusoidal pure tones, bilateral auditory cortical response (P1m) was examined. (3) Results: Significantly shorter P1m latency in the left hemisphere was found for children with ASD without intellectual disabilities than for children with TD. Significant correlation between P1m latency and language conceptual ability was found in children with ASD, but not in children with TD. (4) Conclusions: These findings demonstrated atypical brain maturation in the auditory processing area in children with ASD without intellectual disability. Findings also suggest that ASD has a common neural basis for pure-tone sound processing and language development. Development of brain networks involved in language concepts in early childhood ASD might differ from that in children with TD.

A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms

Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50-70 % of this population exhibiting decreased sound tolerance (DST) at some point in their lives. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. However, relatively little is known about its phenomenology or neurocognitive underpinnings. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.

Genome-wide association study identifies 7q11.22 and 7q36.3 associated with noise-induced hearing loss among Chinese population

Noise-induced hearing loss (NIHL) seriously affects the life quality of humans and causes huge economic losses to society. To identify novel genetic loci involved in NIHL, we conducted a genome-wide association study (GWAS) for this symptom in Chinese populations. GWAS scan was performed in 89 NIHL subjects (cases) and 209 subjects with normal hearing who have been exposed to a similar noise environment (controls), followed by a replication study consisting of 53 cases and 360 controls. We identified that four candidate pathways were nominally significantly associated with NIHL, including the Erbb, Wnt, hedgehog and intraflagellar transport pathways. In addition, two novel index single-nucleotide polymorphisms, rs35075890 in the intron of AUTS2 gene at 7q11.22 (combined P = 1.3 × 10^-6 ) and rs10081191 in the intron of PTPRN2 gene at 7q36.3 (combined P = 2.1 × 10^-6 ), were significantly associated with NIHL. Furthermore, the expression quantitative trait loci analyses revealed that in brain tissues, the genotypes of rs35075890 are significantly associated with the expression levels of AUTS2, and the genotypes of rs10081191 are significantly associated with the expressions of PTPRN2 and WDR60. In conclusion, our findings highlight two novel loci at 7q11.22 and 7q36.3 conferring susceptibility to NIHL.

Stress and coping strategies for parenting children with hearing impairment and autism

OBJECTIVES

To determine the level of stress experienced and coping strategies used by parents of hearing impaired and autistic children.

METHODS

Using non-probability convenience sampling this cross sectional study recruited n =200 parents of hearing impaired (HI) and 100 parents of autistic children, of either gender, aged 20 to 60 years. Samples were recruited from Special Education Institutes of Islamabad and Rawalpindi, over a period of six months, from October 2018 to March 2019 and conducted at Isra Institute of Rehabilitation Sciences, Islamabad. Basic demographical sheet, Parental Stress Scale and Coping Strategies Inventory were used for data collection. Statistical analysis was done using SPSS 21.

RESULTS

In parents of hearing impaired the mean parental stress score was 47.44±12.85 and commonest coping strategy was problem focused engagement (26.03) followed by problem focused dis-engagement (24.25). In the autistic group the mean parental stress score was 48.92+11.22 with problem focused engagement being the most frequently used strategy (27.4) followed by emotion focused strategy.

CONCLUSION

Different level of stress experienced by parents of autistic and hearing impaired children which is statistically significant and they employed different coping strategies.

Auditory Brainstem Pathology in Autism Spectrum Disorder: A Review

Atypical responses to sound are common in individuals with autism spectrum disorder (ASD), and growing evidence suggests an underlying auditory brainstem pathology. This review of the literature provides a comprehensive account of the structural and functional evidence for auditory brainstem abnormalities in ASD. The studies reviewed were published between 1975 and 2016 and were sourced from multiple online databases. Indices of both the quantity and quality of the studies reviewed are considered. Findings show converging evidence for auditory brainstem pathology in ASD, although the specific functions and anatomical structures involved remain equivocal. Two main trends emerge from the literature: (1) abnormalities occur mainly at higher levels of the auditory brainstem, according to structural imaging and electrophysiology studies; and (2) brainstem abnormalities appear to be more common in younger than older children with ASD. These findings suggest delayed maturation of neural transmission pathways between lower and higher levels of the brainstem and are consistent with the auditory disorders commonly observed in ASD, including atypical sound sensitivity, poor sound localization, and difficulty listening in background noise. Limitations of existing studies are discussed, and recommendations for future research are offered.

Click-evoked auditory brainstem responses and autism spectrum disorder: A meta-analytic review

Behavior does not differentiate ASD risk prior to 12 months of age, but biomarkers may inform risk before symptoms emerge. Click-evoked auditory brainstem responses (ABRs) may be worth consideration due to their measurement properties (noninvasiveness; reliability) and conceptual features (well-characterized neural generators), but participant characteristics and assessment protocols vary considerably across studies. Our goal is to perform a meta-analysis of the association between ABRs and ASD. Following an electronic database search (PubMed, Medline, PsycInfo, PsycArticles), we included papers that were written in English, included ASD and typically-developing (TD) groups, and reported the information needed to calculate standardized mean differences (Hedges's g) for at least one ABR latency component (I, III, V, I-III, III-V, I-V). We weighted and averaged effect sizes across conditions and subsets of participants to yield one estimate per component per study. We then performed random-effects regressions to generate component-specific estimates. ASD was associated with longer ABR latencies for Waves III (g = 0.5, 95% CI 0.1, 0.9), V (g = 0.7, 95% CI 0.3, 1.1), I-III (g = 0.7, 95% CI 0.2, 1.2), and I-V (g = 0.6, 95% CI 0.2, 1.0). All components showed significant heterogeneity. Associations were strongest among participants ≤8 years of age and those without middle ear abnormalities or elevated auditory thresholds. In sum, associations between ABRs and ASD are medium-to-large in size, but exhibit heterogeneity. Identifying sources of heterogeneity is challenging, however, due to power limitations and co-occurrence of sample/design characteristics across studies. Research addressing the above limitations is crucial to determining the etiologic and/or prognostic value of ABRs for ASD. Autism Res 2018, 11: 916-927. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Auditory brainstem responses (ABR) may be associated with ASD, but participant characteristics and assessment protocols vary considerably across individual studies. Our goal is to combine the results across these studies to facilitate clarity on the topic. Doing so represents a first step in evaluating whether ABRs yield potential for informing the etiology of ASD risk and/or ASD symptom profiles.

Auditory brainstem response in infants and children with autism spectrum disorder: A meta-analysis of wave V

Infants with autism spectrum disorder (ASD) were recently found to have prolonged auditory brainstem response (ABR); however, at older ages, findings are contradictory. We compared ABR differences between participants with ASD and controls with respect to age using a meta-analysis. Data sources included MEDLINE, EMBASE, Web of Science, Google Scholar, HOLLIS, and ScienceDirect from their inception to June 2016. The 25 studies that were included had a total of 1349 participants (727 participants with ASD and 622 controls) and an age range of 0-40 years. Prolongation of the absolute latency of wave V in ASD had a significant negative correlation with age (R2 = 0.23; P = 0.01). The 22 studies below age 18 years showed a significantly prolonged wave V in ASD (Standard Mean Difference = 0.6 [95% CI, 0.5-0.8]; P < 0.001). The 3 studies above 18 years of age showed a significantly shorter wave V in ASD (SMD = -0.6 [95% CI, -1.0 to -0.2]; P = 0.004). Prolonged ABR was consistent in infants and children with ASD, suggesting it can serve as an ASD biomarker at infancy. As the ABR is routinely used to screen infants for hearing impairment, the opportunity for replication studies is extensive. Autism Res 2018, 11: 355-363. © 2017 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.

LAY SUMMARY

Our analysis of previous studies showed that infants and children with autism spectrum disorder (ASD) have a slower brain response to sound, while adults have a faster brain response to sound. This suggests that slower brain response in infants may predict ASD risk. Brain response to sound is routinely tested on newborns to screen hearing impairment, which has created large data sets to afford replication of these results.

Neural Correlates of Sensory Abnormalities Across Developmental Disabilities

Abnormalities in sensory processing are a common feature of many developmental disabilities (DDs). Sensory dysfunction can contribute to deficits in brain maturation, as well as many vital functions. Unfortunately, while some patients with DD benefit from the currently available treatments for sensory dysfunction, many do not. Deficiencies in clinical practice surrounding sensory dysfunction may be related to lack of understanding of the neural mechanisms that underlie sensory abnormalities. Evidence of overlap in sensory symptoms between diagnoses suggests that there may be common neural mechanisms that mediate many aspects of sensory dysfunction. Thus, the current manuscript aims to review the extant literature regarding the neural correlates of sensory dysfunction across DD in order to identify patterns of abnormality that span diagnostic categories. Such anomalies in brain structure, function, and connectivity may eventually serve as targets for treatment.

Magnetoencephalographic Imaging of Auditory and Somatosensory Cortical Responses in Children with Autism and Sensory Processing Dysfunction

This study compared magnetoencephalographic (MEG) imaging-derived indices of auditory and somatosensory cortical processing in children aged 8–12 years with autism spectrum disorder (ASD; N = 18), those with sensory processing dysfunction (SPD; N = 13) who do not meet ASD criteria, and typically developing control (TDC; N = 19) participants. The magnitude of responses to both auditory and tactile stimulation was comparable across all three groups; however, the M200 latency response from the left auditory cortex was significantly delayed in the ASD group relative to both the TDC and SPD groups, whereas the somatosensory response of the ASD group was only delayed relative to TDC participants. The SPD group did not significantly differ from either group in terms of somatosensory latency, suggesting that participants with SPD may have an intermediate phenotype between ASD and TDC with regard to somatosensory processing. For the ASD group, correlation analyses indicated that the left M200 latency delay was significantly associated with performance on the WISC-IV Verbal Comprehension Index as well as the DSTP Acoustic-Linguistic index. Further, these cortical auditory response delays were not associated with somatosensory cortical response delays or cognitive processing speed in the ASD group, suggesting that auditory delays in ASD are domain specific rather than associated with generalized processing delays. The specificity of these auditory delays to the ASD group, in addition to their correlation with verbal abilities, suggests that auditory sensory dysfunction may be implicated in communication symptoms in ASD, motivating further research aimed at understanding the impact of sensory dysfunction on the developing brain.

Synchrony of auditory brain responses predicts behavioral ability to keep still in children with autism spectrum disorder: Auditory-evoked response in children with autism spectrum disorder

The auditory-evoked P1m, recorded by magnetoencephalography, reflects a central auditory processing ability in human children. One recent study revealed that asynchrony of P1m between the right and left hemispheres reflected a central auditory processing disorder (i.e., attention deficit hyperactivity disorder, ADHD) in children. However, to date, the relationship between auditory P1m right-left hemispheric synchronization and the comorbidity of hyperactivity in children with autism spectrum disorder (ASD) is unknown. In this study, based on a previous report of an asynchrony of P1m in children with ADHD, to clarify whether the P1m right-left hemispheric synchronization is related to the symptom of hyperactivity in children with ASD, we investigated the relationship between voice-evoked P1m right-left hemispheric synchronization and hyperactivity in children with ASD. In addition to synchronization, we investigated the right-left hemispheric lateralization. Our findings failed to demonstrate significant differences in these values between ASD children with and without the symptom of hyperactivity, which was evaluated using the Autism Diagnostic Observational Schedule, Generic (ADOS-G) subscale. However, there was a significant correlation between the degrees of hemispheric synchronization and the ability to keep still during 12-minute MEG recording periods. Our results also suggested that asynchrony in the bilateral brain auditory processing system is associated with ADHD-like symptoms in children with ASD.

Children with autism spectrum disorder have reduced otoacoustic emissions at the 1 kHz mid-frequency region

Autism spectrum disorder (ASD) is a behaviorally diagnosed disorder of early onset characterized by impairment in social communication and restricted and repetitive behaviors. Some of the earliest signs of ASD involve auditory processing, and a recent study found that hearing thresholds in children with ASD in the mid-range frequencies were significantly related to receptive and expressive language measures. In addition, otoacoustic emissions have been used to detect reduced cochlear function in the presence of normal audiometric thresholds. We were interested then to know if otoacoustic emissions in children with normal audiometric thresholds would also reveal differences between children with ASD and typical developing (TD) controls in mid-frequency regions. Our objective was to specifically measure baseline afferent otoacoustic emissions (distortion-product otoacoustic emissions [DPOAEs]), transient-evoked otoacoustic emissions (TrOAEs), and efferent suppression, in 35 children with high-functioning ASD compared with 42 aged-matched TD controls. All participants were males 6-17 years old, with normal audiometry, and rigorously characterized via Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Children with ASD had greatly reduced DPOAE responses in the 1 kHz frequency range, yet had comparable DPOAE responses at 0.5 and 4-8 kHz regions. Furthermore, analysis of the spectral features of TrOAEs revealed significantly decreased emissions in ASD in similar frequencies. No significant differences were noted in DPOAE or TrOAE noise floors, middle ear muscle reflex activity, or efferent suppression between children with ASD and TD controls. In conclusion, attention to specific-frequency deficits using non-invasive measures of cochlear function may be important in auditory processing impairments found in ASD. Autism Res 2017, 10: 337-345. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Atypical Bilateral Brain Synchronization in the Early Stage of Human Voice Auditory Processing in Young Children with Autism

Autism spectrum disorder (ASD) has been postulated to involve impaired neuronal cooperation in large-scale neural networks, including cortico-cortical interhemispheric circuitry. In the context of ASD, alterations in both peripheral and central auditory processes have also attracted a great deal of interest because these changes appear to represent pathophysiological processes; therefore, many prior studies have focused on atypical auditory responses in ASD. The auditory evoked field (AEF), recorded by magnetoencephalography, and the synchronization of these processes between right and left hemispheres was recently suggested to reflect various cognitive abilities in children. However, to date, no previous study has focused on AEF synchronization in ASD subjects. To assess global coordination across spatially distributed brain regions, the analysis of Omega complexity from multichannel neurophysiological data was proposed. Using Omega complexity analysis, we investigated the global coordination of AEFs in 3–8-year-old typically developing (TD) children (n = 50) and children with ASD (n = 50) in 50-ms time-windows. Children with ASD displayed significantly higher Omega complexities compared with TD children in the time-window of 0–50 ms, suggesting lower whole brain synchronization in the early stage of the P1m component. When we analyzed the left and right hemispheres separately, no significant differences in any time-windows were observed. These results suggest lower right-left hemispheric synchronization in children with ASD compared with TD children. Our study provides new evidence of aberrant neural synchronization in young children with ASD by investigating auditory evoked neural responses to the human voice.