The Use of Listening Devices to Ameliorate Auditory Deficit in Children with Autism Gary Rance, BEd, DipAud, MSc, PhD 1 , Kerryn Saunders, MBBS(Hons), RACP 2 , Peter Carew, BSc, MAud 1 , Marlin Johansson, BSc, MAud 3 , and Johanna Tan, BSc, MAud 1 Objectives To evaluate both monaural and binaural processing skills in a group of children with autism spectrum disorder (ASD) and to determine the degree to which personal frequency modulation (radio transmission) (FM) listening systems could ameliorate their listening difficulties. Study design Auditory temporal processing (amplitude modulation detection), spatial listening (integration of binaural difference cues), and functional hearing (speech perception in background noise) were evaluated in 20 chil- dren with ASD. Ten of these subsequently underwent a 6-week device trial in which they wore the FM system for up to 7 hours per day. Results Auditory temporal processing and spatial listening ability were poorer in subjects with ASD than in matched controls (temporal: P = .014 [95% CI 6.4 to 0.8 dB], spatial: P = .003 [1.0 to 4.4 dB]), and per- formance on both of these basic processing measures was correlated with speech perception ability (temporal: r = 0.44, P = .022; spatial: r = 0.50, P = .015). The provision of FM listening systems resulted in improved discrimination of speech in noise (P < .001 [11.6% to 21.7%]). Furthermore, both participant and teacher ques- tionnaire data revealed device-related benefits across a range of evaluation categories including Effect of Background Noise (P = .036 [60.7% to 2.8%]) and Ease of Communication (P = .019 [40.1% to 5.0%]). Eight of the 10 participants who undertook the 6-week device trial remained consistent FM users at study completion. Conclusions Sustained use of FM listening devices can enhance speech perception in noise, aid social interac- tion, and improve educational outcomes in children with ASD. (J Pediatr 2014;164:352-7). A typical responses to sensory stimuli across a number of modalities including the visual, tactile, and auditory are frequently reported and are now a mandatory component of autism spectrum disorder (ASD) diagnosis as specified in the Diagnostic and Statistical Manual of Mental Disorders–Version 5. 1 Aberrant reactions to auditory stimuli were noted in Kanner’s original article on autism 2 and recent evidence has suggested that a high proportion of affected children suffer auditory processing deficits that particularly disrupt the ability to hear and understand speech in the presence of background noise. 3-5 Identification and appropriate management of hearing problems in this population are especially important as audi- tory deficits can, in themselves, restrict social and communication development. 6 There are 2 main approaches to reducing functional hearing deficit in children with listening-in-noise (figure/ground) prob- lems. The first is to improve the quality of the signal reaching the child’s ear, and the second is to train him/her to make the best use of that signal. In the case of the latter, results of training programs for children with ASD have not been reported, but there is a growing amount of literature suggesting that figure/ground deficit may be ameliorated through targeted auditory habilita- tion. 7-9 Optimization of the listening environment (particularly in the school setting) is important and can be achieved through structural modifications (fitting of ceiling tiles, carpets, etc) and sound field (loudspeaker) amplification of the teacher’s voice. 10 Another option is the use of personal frequency modulation (radio transmission) (FM) listening systems. These devices transmit speech signals (detected by a lapel microphone worn by the speaker/teacher) via radio waves to ear-level receivers worn by the child. As such, they improve the signal-to-noise ratio as the speech is louder, relative to the background noise at the child’s ear. FM devices have been used effectively to minimize listening problems for children with cochlear hearing loss, 11 cen- tral auditory processing deficit, 12 and auditory neuropathy. 13 Furthermore, a recent pilot investigation by Schafer et al 14 has shown listening benefits for ASD children wearing FM systems for short periods in “structured” educational situations. The sustained use of these devices in mainstream classroom environ- ments has, however, has not yet been explored in children with ASD. From the 1 Department of Audiology and Speech Pathology, The University of Melbourne; 2 School of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; and 3 Department of Audiology, School of Medicine, Lund University, Lund, Sweden Funded by the Jack Brockhoff Foundation, the Collier Foundation, and the Deafness Foundation. PHONAK.org donated the FM devices. The authors declare no con- flicts of interest. 0022-3476/$ - see front matter. Copyright ª 2014 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.09.041 APHAB Abbreviated Profile of Hearing Aid Benefit ASD Autism spectrum disorder FM Frequency modulation (radio transmission) 352