Visual Reinforcement Audiometry Versus Video Visual Reinforcement Audiometry in Children with Autism Spectrum Disorder and Other Developmental Disabilities
Megan Costanzo, B.A. Test Facility – Waisman Center Audiology Extern at Mayo Clinic Health System, La Crosse, WI 4th Year Doctoral Student of Audiology University of Wisconsin-Madison Outline
• Background • Methods • Results • Conclusions • Acknowledgements • References Outline
• Background • Methods • Results • Conclusions • Acknowledgements • References Autism Overview
• DSM5 Guidelines:
Social Repetitive Impairment Behavior
Symptoms Symptoms in Limit Daily Early Ages Function • Varying data on prevalence of Autism Spectrum Disorder (ASD) and hearing loss (HL)[1] Differences between Autism and Hearing Loss[2]
Autism Spectrum Disorder Hearing Loss 18 months of age 0 months of age Lack of joint attention Normal motor Repetitive behaviors development
Similarities between Autism and Hearing Loss[2]
Unintelligible speech Delayed speech and language Disinterest in environmental sounds or conversation Sensitive to touching of ears Poor eye contact Statistics on Children in U.S.
2-3:1,000 congenital HL[3]
3:4 ear infection by age 3[3]
1:68 diagnosed with ASD[4]
1.7-4% have HL & ASD[5, 6] Significance
Must know Outcomes
How to If HL is missed evaluate
If HL is When to refer identified early Project Goals
Identify alternate approaches to evaluate hearing of children with special needs
Gather research data for special populations Outline
• Background • Methods • Results • Conclusions • Acknowledgements • References Visual Reinforcement Audiometry (VRA)
Beep!
Beep!
• Successful between developmental ages of 5-36 months[2] VRA Set-Up Video Visual Reinforcement Audiometry (V-VRA)
Beep!
Beep!
• No previous studies have looked at ASD or other developmental disabilities V-VRA Set-Up Test Room Set-Up
Participants • Inclusion criteria – Children referred to the Waisman Center with ASD or other developmental disabilities – Children from 6 mos. to 6 years of age who can be assessed through VRA • Exclusion criteria – Children who cannot be reliably tested through VRA Methods
• Test order • Transducer • Conditioning phase • Initial stimulus presentation: 40 dB HL • Control trials • Maladaptive behaviors Outline
• Background • Methods • Results • Conclusions • Acknowledgements • References Data Collection Subject Sex Age Diagnosis A001 M 33 months Autism Spectrum Disorder A002 M 30 months Autism Spectrum Disorder A003 M 34 months Apraxia of Speech A004 F 5 years Developmental Delay, Gross Motor Delay
A005 F 3 years Hypotonia, Chromosomal Abnormality A006 M 23 months Spastic Displasia V001 M 21 months Developmental Delay Developmental Communication Disorder, Gross V002 M 4 years Motor Delay, Other Developmental S/L Disorder V003 M 27 months Expressive Language Delay V004 M 21 months Developmental Delays V005 M 33 months Initial ASD consult V006 M 22 months Newborn Follow-Up, Speech/Language Delays Subject Profiles ComparisonComparison of Reinforcement of Reinforcement Method Method
24
22 VRA V-VRA
20
18
16
14
12
Total Number of Head Turnsof Head Total Number
10 Total Number of Head Turns Head of Number Total
8 VRA V-VRA ResponseResponse ConsistencyConsistency 1.0
VRA V-VRA 0.8
0.6
Hit Rate
Hit Rate Hit 0.4
0.2
0.0
TrialTrial Outline
• Background • Methods • Results • Conclusions • Acknowledgements • References Response Consistency Comparison
Lowery, von Hapsburg,
CurrentResponse Consistency Study Plyler, and Johnstone (2009) 1.0
VRA V-VRA 0.8
0.6
Hit Rate 0.4
0.2
Hit Rate Hit Hit Rate Hit
0.0 TrialTrial VRA V-VRA Summary of Findings
• No significant difference between VRA and V-VRA – Number of head turns – Hit rate • No child reacted negatively to V-VRA • V-VRA viable option for testing hearing in children with ASD and other developmental disabilities Special Time to test populations Challenges to currentLimitations study One test Incomplete condition evaluations What Next?
Develop published Crossover protocol design
Larger sample Clinical Implications
• Room for more research • Additional methods of testing • Benefit for clinic – Accessibility of equipment – Cost-efficient – Behavioral testing A Special Thanks to… • Waisman Center – Participants and their families – Waisman Center clinical staff • Jon Douglas, Au.D. • Jane Elliot, Au.D. • Ruth Litovsky, Ph.D. • Sammi Ginter, M.A. • Sara Misurelli, Ph.D. • Shelly Godar, M.A.
References • 1 Kleinman, J.M., Robins, D.L., Ventola, P.E., Pandey, J., Boorstein, H.C., Esser, E.L., …Deborah Fein. (2008). "The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders." Journal of Autism Development Disorders 38, 827-39. • 2 Katz, Jack, Robert Burkard, and Larry Medwetsky. (2002). Ch. 26, Individuals with Multiple Disabilities. Handbook of Clinical Audiology (668). Philadelphia: Lippincott Williams &Wilkins. 6th Edition. • 3 Compiled by National Institute on Deafness and Other Communication Disorders. “Quick Statistics.” National Institute on Deafness and Other Communication Disorders. 16 June 2010. Web. 21 April 2014. https://www.nidcd.nih.gov/health/statistics/Pages/quick.aspx. • 4 Baio, Jon. (2014). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network 11 Sites, United States, 2010. Surveillance Summaries 63: 1-21. • 5 C.A. Szymanski, P.J. Brice, K.H. Lam, S.A. Hotto. (2012). Deaf children with autism spectrum disorders. Journal of Autism Developmental Disorders 42: 2027-2037. • 6 R. Jure, I. Rapin, R.F. Tuchman. (1991). Hearing-impaired autistic children. Developmental Medicine Child Neurology, 33: 1062–1072. • Images obtained from: http://www.123rf.com/photo_8439686_a-handsome-boy-is-sitting- and-holding-his-head-with-his-fist-isolated-on-the-white-background.html, http://www.caretolearn.net/infant_program.php
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