Knowing When to Refer: How Audiologists Can Help with Early Screening for Autism Spectrum Disorder

Nora Erickson1, Sumathi Rachamadugu2, Lydia Rogers2, Lisa Rose3, Vicki Simonsmeier3, Tracy Smith2,Stephanie Browning McVicar4, Gwen Mitchell5, & Janice Palumbos2

1Washington State University, 2 University of Utah, 3Utah State University, 4Utah Department of Health: Children with Special Healthcare Needs, 5University of Idaho

Objectives

1. Understand the importance of early screening for Autism Spectrum Disorder (ASD)

2. Identify why the audiologist is in a unique position to aid in early identification of ASD

3. Create an online learning module to support audiologists in making appropriate referrals based on developmental concerns

Hearing Loss and ASD• Reliable diagnosis of ASD ~24 months of age• Early signs of ASD observable within the first year of life

• About 4% of children with HL have ASD

• Median age of diagnosis• Hearing loss: 14 months • ASD: 53 months• Dual diagnosis: 66.5 months

Jure, Rapin, & Tuchman, 1991; Meinzen-Derr, Wiley, Bishop, Manning-Courtney, Choo, & Murray, 2014; Morbidity and Mortality Weekly Report, Surveillance Summaries, 2014; Meinzen-Derr et al., 2014

Why audiologists?

• Universal screening success

• Early point of referral for speech-language delays

• May be the first referral for a child with ASD

• It’s in the scope of practiceHarlor & Bower, 2009; Tas et al., 2007; Myck-Wayne et al., 2013

Why it’s worthwhile• Amplification still warranted • Potential missed window of opportunity for

intervention• ASD-specific• Hearing loss

• Early intervention• Reductions in ASD symptomatology

Meinzen-Derr et al., 2014; Zweigenbaum, Bryson, & Garon, 2013; Dawson, 2008

The Electronic Library

Online Learning• Housed in a digital repository using Equella• Self-paced and asynchronous sequential series• Comparable with traditional lecture instruction • Can serve a vital role in clinical development for

practicing audiologist• Flexible self-paced learning• Ability to review the information multiple times• Ease of access

Modules in the Electronic Library

Module Topics1. Introduction • Demographics of ASD and hearing loss• Role of audiologist in early screening for ASD

2. Etiology of ASD• Genetic factors• Environmental factors

3. Identifying ASD• Red Flags• DSM-5 Criteria

Module Topics4. Evaluation Accommodations • ASD-associated behaviors • Sensory

5. Sensitive and Appropriate Referrals● Screening ● Assessment process● Where to make appropriate referrals● How to make sensitive referrals

4. Resources • Audiologists• Parents

Sample Module

2015 EHDI Conference

Future Directions• Feedback from audiologists

• Complete remaining modules

References•American Speech-Language-Hearing Association. (2006). Guidelines for speech-

language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span [Guidelines]. Available from www.asha.org/policy.•American Psychiatric Association. (2013). Diagnostic and statistical manual of

mental disorders: DSM-5. Washington, D.C: American Psychiatric Association•American Speech-Language-Hearing Association Special Interest Group 9. (2013).

Perspectives on hearing and hearing disorders in childhood, 23(1), 1-26.•Beers, A. N., McBoyle, M., Kakande, E., Dar Santos, R. C., & Kozak, F. K. (2014). Autism

and peripheral hearing loss: A systematic review. International Journal of Pediatric Otorhinolaryngology, 78(1), 96–101. doi:http://dx.doi.org/10.1016/j.ijporl.2013.10.063•Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the

prevention of autism spectrum disorder. Development and Psychopathology, 20, 775-803.

References• Jure, R., Rapin, I., & Tuchman, R. F. (1991). Hearing-impaired autistic children.

Developmental Medicine and Child Neurology, 33(12), 1062–1072.• Meinzen-Derr, J., Wiley, S., Bishop, S., Manning-Courtney, P., Choo, D.I., & Murray, D.

(2014). Autism spectrum disorders in 24 children who are deaf or hard of hearing. International Journal of Pediatric Otorhinolaryngology, 78(1), 112-118.

• Myck-Wayne, J., Robinson, S., & Henson, E. (2011). Serving and supporting young children with a dual diagnosis of hearing loss and autism: The stories of four families. American Annals of the Deaf, 156, 379-390.

• Oosterling, I.J., Wensing, M., Swinkels, S.H., van der Gaag, R.J., Visser, J.C., Woudenberg, T... & Buitelaar, J.K. (2010). Advancing early detection of autism spectrum disorder by applying an integrated two-stage screening approach. Journal of Child Psychology and Psychiatry, 51, 250–258.

• Tas, A., Yagiz, R., Tas, M., Esme, M., Uzun, C. & Karasalihoglu, A.R. (2007). Evaluation of hearing in children with autism by using TEOAE and ABR. Autism, 11, 73-79.

• Harlor, A. J., & Bower, C. (2009). Hearing assessment in infants and children: Recommendations beyond neonatal screening. Pediatrics, 124(4), 1252-1263. doi:10.1542/peds.2009-1997

References• Chang, J., Sarah, G., Andrew H.C., Stephan J.S., & Dennis, V. (2015). Genotype to

phenotype relationships in autism spectrum disorders. Nature Neuroscience, 18(2), 191-199.

• Geschwind D.H. (2011). Genetics of autism spectrum disorders. Trends Cogn Sci., 15(9), 409-416.

• Rosti, R.O., Sadek, A.A., Vaux K.K., & Gleeson, J.G. (2013). The genetic landscape of autism spectrum disorders. Developmental medicine and child neurology,

• Kennedy, T., Regehr, G., Rosenfield, J., Roberts, S.W., and Lingard, L., (2004). Exploring the gap between knowledge and behavior: A qualitative study of clinician action following an educational intervention. Academic Medicine, 79, 386-393.

• Zwaigenbaum, L., Bryson, S., & Garon, N. (2013). Early identification of autism spectrum disorders. Behavioural Brain Research, 251, 133–146. doi:http://dx.doi.org/10.1016/j.bbr.2013.04.004