The use of FM technology in children with Autism Spectrum Disorder … · 2020-05-27 ·...
Transcript of The use of FM technology in children with Autism Spectrum Disorder … · 2020-05-27 ·...
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The Use of FM
Technology in
school-aged children
with Autism
Spectrum Disorder
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The Use of FM Technology in
School-Aged children with
Autism Spectrum Disorder
Gary Rance, Kerryn Saunders, Peter Carew,
Marlin Johansson & Johanna Tan
Advances in Audiology Meeting, Las Vegas, December 2012
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Background
Autism Spectrum Disorder (ASD)
– neurodevelopmental disorder affecting 1 in 120 children
Behavioural symptoms
– social interaction impairment
– communication deficit
– restricted, repetitive and stereotyped patterns of activity/interest
Sensory deficits (particularly auditory)
– consistently reported speech perception in noise deficits
(Ornitz et al. 1989; Alcantara et al. 2004)
– inability to use brief gaps in noise to gain release from masking
(Groen et al. 2009)
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Study Aims
Characterize the pattern of auditory deficits
in children with ASD
Determine whether FM-listening devices
can improve speech understanding/general
communication
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Study Design
Initial test session
– Psychophysical & formal speech perception testing
– FM device fitting (Inspiro device / iSense micro receiver)
– Comparison of aided (FM) and unaided scores
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Study Design
6 week FM trial
»1. Period of non-use (prior to fitting)
»2. Two week period wearing the device
»3. Another two week period wearing the device
»4. Two week period of non-use
– Subjects completed a hearing disability questionnaire
at the end of each period (APHAB)
– Teacher survey at end of trial (LIFE)
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Subjects
20 children with ASD
– Diagnosis: Childhood Autism Rating Scale (CARS)
– Intelligence/Cognitive Profile:
Wechsler Intelligence Scale for Children (IQ>80)
– Education
– All in mainstream settings: secondary N=10, primary N=10
– Age range: 8 to 15.4 yrs
20 controls matched for age/gender/hearing level
– Identical test battery (apart from the FM trial)
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Psychophysical Protocol
Audiogram (4-freq average)
– ASD: 12.6±6.4 dBHL
– Control: 10.4±8.3 dBHL
Temporal Resolution
– Ability to detect changes in stimuli over time
– Temporal modulation transfer function
(TMTF)
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Temporal Modulation Transfer Function (TMTF)
Determines the listener’s ability
to perceive rapid amplitude
changes in a continuous signal
Variables
– Modulation rate
– Modulation depth
100%
(0dB)
50%
(-6dB)
10%
(-20dB)
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-20
-18
-16
-14
-12
-10
1 10 100 1000
Control
ASD
Modulation Rate (Hz)
Mod
. D
epth
20
log
M (
dB
) Temporal Modulation Transfer Function
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-20
-18
-16
-14
-12
-10
1 10 100 1000
Control
ASD
Modulation Rate (Hz)
Mod
. D
epth
20
log
M (
dB
) Temporal Modulation Transfer Function
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Spatial Processing
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Binaural Speech Perception
• Listening in Spatialized Noise Test (LiSN-S)
• Speech in background noise
• Measures the listener’s ability to use spatial cues to
improve perception
• Spatial Advantage
• Difference in speech reception threshold (SRT)
• 2 test conditions:
• Target speech and noise presented from the same direction
(i.e. no spatial cues available)
• Target and noise spatially separated (900)
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0
3
6
9
12
15
18
8 10 12 14 16
Age (Years)
Sp
ati
al
Ad
van
tage (
dB
)core
LiSN-S Spatial Advantage
Control ASD
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0
3
6
9
12
15
18
8 10 12 14 16
Age (Years)
Sp
ati
al
Ad
van
tage (
dB
)core
LiSN-S Spatial Advantage
Control ASD
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Hearing Disability Survey
Abbreviated Profile of Hearing Aid Benefit
(APHAB)
Self-assessment survey examining various aspects
of everyday listening and communication
Evaluation categories
– Ease of communication
– Listening in background noise
– Effect of reverberation
– Aversion to sound
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0
10
20
30
40
50
60
Communication Noise Reverberation Aversiveness Total
Per
ceiv
ed D
iffi
cult
y (
%)
APHAB (unaided) Control (N=20) ASD (N=20)
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0
10
20
30
40
50
60
Communication Noise Reverberation Aversiveness Total
Per
ceiv
ed D
iffi
cult
y (
%)
APHAB (unaided)
*
*
* * *
Control (N=20) ASD (N=20)
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Management of
speech in noise
problems
Personal FM systems
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FM Test Setup: Free Field Speech in Noise
Speech: CNC words - 65 dBSPL
+0 dB S/N ratio (at the subject’s head)
(noise) (speech)
*
FM lapel
microphone
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Results: Free-field Speech in Noise
Control Group (N=20)
– unaided: 78.9 8.4%
– aided (FM device): 89.1 4.0%
ASD Group (N=20)
– unaided: 68.9 11.7%
– aided (FM device): 85.6 5.1%
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0
20
40
60
80
1001 2 3 4 5 6 7 8 9
10
11
12
12
14
15
16
17
18
19
20
Mea
n
Subject #
CN
C P
hon
eme
Sco
re (
%)
Unaided/FM-Aided Speech Scores (ASD)
unaided FM-aided
*
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6 Week FM-Device Trial
Secondary School Children: 13-15 yrs (N=10)
– All rejected
» Resistance from the child
» Inconsistent teacher support
Primary School Children: 8-12 yrs (N=10)
– 5 completed
– 3 mid-trial: all consistent users at this stage
– 2 rejected
» Both had significant behavioural problems
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0
10
20
30
40
50
60
Communication Noise Reverberation Aversiveness Total
Per
ceiv
ed D
iffi
cult
y (
%) Unaided (N=5) FM-aided (N=5)
APHAB: unaided v aided (ASD)
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0
10
20
30
40
50
60
Communication Noise Reverberation Aversiveness Total
Per
ceiv
ed D
iffi
cult
y (
%)
*
*
* *
APHAB: unaided v aided (ASD)
Unaided (N=5) FM-aided (N=5)
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Educational Impact
Listening Inventory For Education (LIFE)
Completed by classroom teacher at the end of the FM-trial
Aims to determine the efficacy of device usage
16 questions
– 1. “Focus on instructions has improved”
– 2. “Appears to understand instructions better”
– 14. “Socially more involved with other children”
Agree No Change Disagree
(2) (1) (0) (-1) (-2)
Maximum score = 35
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8
9
10
11
12
-35 -28 -21 -14 -7 0 7 14 21 28 35
LIFE Score
Su
bje
ct A
ge
Listening Inventory For Education (LIFE) ASD Participants
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8
9
10
11
12
-35 -28 -21 -14 -7 0 7 14 21 28 35
LIFE Score
Su
bje
ct A
ge
Listening Inventory For Education (LIFE) ASD Participants
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Conclusions
ASD participants showed monaural & binaural auditory
processing deficits
Impaired speech perception (in noise) and a greater
degree of everyday listening/communication difficulty
All ASD subjects showed better speech perception in
noise when wearing the FM device
– teenagers failed to complete the FM trial
– most of the younger participants (8-12 yrs) were still
enthusiastic device users 6 weeks post-fitting
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Acknowledgements
Co-authors
– Dr Kerryn Saunders: Pediatrician
– Peter Carew: Audiologist, The University of Melbourne
– Johanna Tan: Audiologist, The University of Melbourne
– Marlin Johansson: Master of Audiology Student,
(Lund University, Sweden)
Hardware
– Phonak: who donated the FM systems
Funding Support
– Jack Brockhoff & Collier Foundations
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Thankyou