Promoting Literacy in Students With ASD: The Basics for the SLP

from Language, Speech, and Hearing Services in Schools

Purpose: This article provides a tutorial for speech-language pathologists (SLPs) concerning approaches for improving the reading skills of students with autism spectrum disorder (ASD). SLPs are encouraged to modify their role to include a literacy focus, not only because of inclusion and standardized reading tests, but also because SLPs offer skills to enrich the literacy skills of students with ASD.

Method: This article is organized to provide guidance on approaches associated with reading achievements in 3 stages of development: (a) emergent, (b) conventional, and (c) skilled reading. For each, we provide a brief overview of major achievements observed in students with typical development as well as a synopsis of what is currently known concerning the achievements of students with ASD. We then provide suggestions concerning specific approaches that can be used to further the reading and oral language skills of students with ASD within the particular stage.

Implications: This article suggests literacy interventions that target critical oral language and literacy skills that have been well documented as areas of need among many students with ASD. SLPs can draw on this information when designing and implementing transdiciplinary literacy interventions for this growing population of students whose literacy needs are currently underserved.

Training and Knowledge in Autism Among Speech-Language Pathologists: A Survey

from Language, Speech, and Hearing Services in Schools

Purpose: The current study was designed to answer the following questions: (a) What knowledge do school-based speech-language pathologists (SLPs) have concerning autism? (b) What educational and clinical training do SLPs receive in autism? (c) Do SLPs have confidence in their ability to provide services to children with autism and their families?

Method: An original 52-item survey was designed to answer the research questions. Participants were recruited through e-mail and were asked to respond to a Web-based survey.

Results: Sixty-seven school-based SLPs practicing in 33 states across the United States responded to the survey. Most participants had accurate knowledge about the characteristics of children with autism; however, they had mixed perceptions of diagnostic criteria for autism. Although most participants did address autism at some level of their educational training, little time was spent discussing the topic. Additionally, some SLPs lack confidence in their abilities to provide services to children with autism.
Conclusion: The return rate for participants was small, and it is difficult to generalize the results. However, the majority of respondents reported that they could have benefited from additional training in the area of autism. As a result, it may be necessary to consider strategies for providing this training.

The Impact of Early Intervention on Speech and Lexical Development for Toddlers With Cleft Palate: A Retrospective Look at Outcome

from Language, Speech, and Hearing Services in Schools

Purpose: The purpose of the present investigation was to examine the impact of early intervention on speech and lexical measures for toddlers with cleft palate.

Method: Speech measures of ten 27-month-old toddlers with cleft palate who had been referred for therapy at 17 months of age were compared to those of 10 toddlers with cleft palate who had been referred but did not receive therapy. Both groups were compared to 2 other groups of children who had never been referred for therapy.

Results: Multivariate analysis of variance revealed only 1 significant difference between the children who received therapy and those who did not receive therapy. Children who received therapy produced a significantly greater percentage of glides (p < .001) than did children who did not receive therapy.

Conclusion: The findings of this study indicated that early intervention as conducted by the speech-language pathologists in this study was not as effective as expected for this group of toddlers with cleft palate.

Combined effect of fluid and pressure on middle ear function

from Hearing Research

In our previous studies, the effects of effusion and pressure on sound transmission were investigated separately. The aim of this study is to investigate the combined effect of fluid and pressure on middle ear function. An otitis media with effusion model was created by injecting saline solution and air pressure simultaneously into the middle ear of human temporal bones. Tympanic membrane displacement in response to 90 dB SPL sound input was measured by a laser vibrometer and the compliance of the middle ear was measured by a tympanometer. The movement of the tympanic membrane at the umbo was reduced up to 17 dB by the combination of fluid and pressure in the middle ear over the auditory frequency range. The fluid and pressure effects on the umbo movement in the fluid–pressure combination are not additive. The combined effect of fluid and pressure on the umbo movement is different compared with that of only fluid or pressure change in the middle ear. Negative pressure in fluid–pressure combination had more effect on middle ear function than positive pressure. Tympanometry can detect the middle ear pressure of the fluid–pressure combination. This study provides quantitative information for analysis of the combined effect of fluid and pressure on tympanic membrane movement.

Aging and Speech-on-Speech Masking

from Ear and Hearing

Abstract:
Objectives: A common complaint of many older adults is difficulty communicating in situations where they must focus on one talker in the presence of other people speaking. In listening environments containing multiple talkers, age-related changes may be caused by increased sensitivity to energetic masking, increased susceptibility to informational masking (e.g., confusion between the target voice and masking voices), and/or cognitive deficits. The purpose of the present study was to tease out these contributions to the difficulties that older adults experience in speech-on-speech masking situations.

Design: Groups of younger, normal-hearing individuals and older adults with varying degrees of hearing sensitivity (n = 12 per group) participated in a study of sentence recognition in the presence of four types of maskers: a two-talker masker consisting of voices of the same sex as the target voice, a two-talker masker of voices of the opposite sex as the target, a signal-envelope-modulated noise derived from the two-talker complex, and a speech-shaped steady noise. Subjects also completed a voice discrimination task to determine the extent to which they were able to incidentally learn to tell apart the target voice from the same-sex masking voices and to examine whether this ability influenced speech-on-speech masking.

Results: Results showed that older adults had significantly poorer performance in the presence of all four types of maskers, with the largest absolute difference for the same-sex masking condition. When the data were analyzed in terms of relative group differences (i.e., adjusting for absolute performance) the greatest effect was found for the opposite-sex masker. Degree of hearing loss was significantly related to performance in several listening conditions. Some older subjects demonstrated a reduced ability to discriminate between the masking and target voices; performance on this task was not related to speech recognition ability.

Conclusions: The overall pattern of results suggests that although amount of informational masking does not seem to differ between older and younger listeners, older adults (particularly those with hearing loss) evidence a deficit in the ability to selectively attend to a target voice, even when the masking voices are from talkers of the opposite sex. Possible explanations for these findings include problems understanding speech in the presence of a masker with temporal and spectral fluctuations and/or age-related changes in cognitive function.

(C) 2008 Lippincott Williams & Wilkins, Inc.

Audiovisual Perception of Speech in Noise and Masked Written Text

from Ear and Hearing

act:
Objective: The aim of this study was to examine the support obtained from degraded visual information in the comprehension of speech in noise.

Design: We presented sentences auditorily (speech reception threshold test), visually (text reception threshold test), and audiovisually. Presenting speech in noise and masked written text enabled the quantification and systematic variation of the amount of information presented in both modalities. Eighteen persons with normal hearing (aged 19 to 31 yr) participated. For half of them a bar pattern masked the text and for the other half random dots masked the text. The text was presented simultaneously or delayed relative to the speech. Using an adaptive procedure, the amount of information required for a correct reproduction of 50% of the sentences was determined for both the unimodal and the audiovisual stimuli. Bimodal support was defined as the difference between the observed bimodal performance and that predicted by an independent channels model. Nonparametric tests were used to evaluate the bimodal support and the effect of delaying the text.

Results: Masked text substantially supported the comprehension of speech in noise; the bimodal support ranged from 15% to 25% correct. A negative effect of delaying the text was observed in some conditions for the participants who were presented the text masked by the bar pattern.

Conclusions: The ability of participants to reproduce bimodally presented sentences exceeds the performance as predicted by an independent channels model. This indicates that a relatively small amount of visual information can substantially augment speech comprehension in noise, which supports the use of visual information to improve speech comprehension by participants with hearing impairment, even if the visual information is incomplete.

Clinical Utility of Laser-Doppler Vibrometer Measurements in Live Normal and Pathologic Human Ears

from Ear and Hearing

Abstract:
The laser-Doppler vibrometer (LDV) is a research tool that can be used to quickly measure the sound-induced velocity of the tympanic membrane near the umbo (the inferior tip of the malleus) in live human subjects and patients. In this manuscript we demonstrate the LDV to be a sensitive and selective tool for the diagnosis and differentiation of various ossicular disorders in patients with intact tympanic membranes and aerated middle ears. Patients with partial or total ossicular interruption or malleus fixation are readily separated from normal-hearing subjects with the LDV. The combination of LDV measurements and air-bone gap can distinguish patients with fixed stapes from those with normal ears. LDV measurements can also help differentiate air-bone gaps produced by ossicular pathologies from those associated with pathologies of inner-ear sound conduction such as a superior semicircular canal dehiscence.

Effect of Envelope Enhancement on Speech Perception in Individuals with Auditory Neuropathy

from Ear and Hearing

Abstract:
Objectives: To investigate the ability to identify consonant-vowel (CV) stimuli by individuals with auditory neuropathy (AN) when the envelope of the speech signal is enhanced by15 dB for different modulation bandwidths (3 to 10 Hz; 3 to 20 Hz; 3 to 30 Hz; 3 to 60 Hz).

Design: Eight individuals with auditory neuropathy whose pure-tone thresholds ranged from 30 to 70 dB HL participated in the present study. Speech material consisted of five lists of CV, one unprocessed and four with envelope enhancement. The magnitude of envelope enhancement was 15 dB and the bandwidths used were 3 to 10 Hz, 3 to 20 Hz, 3 to 30 Hz, and 3 to 60 Hz.

Results: Speech identification scores improved when the envelope of the speech was enhanced. The improvement was greater for the broader bandwidth (3 to 30 Hz) conditions when compared with the smaller bandwidth (3 to 10 Hz and 3 to 20 Hz) conditions. In the unprocessed condition, manner of articulation was transmitted better than voicing and place of articulation. In the envelope-enhanced conditions, cues for manner and place of articulation were transmitted better than voicing.

Conclusions: Envelope enhancement using digital techniques improves speech perception by individuals with auditory neuropathy, and it may be a viable option for the rehabilitation of these individuals. However, the magnitude of envelope enhancement of speech required for maximal improvement of speech perception is yet to be determined.

(C) 2008 Lippincott Williams & Wilkins, Inc.

Hearing Handicap Ratings Among Different Profiles of Adult Cochlear Implant Users

from Ear and Hearing

Abstract:
Objective: The aim was to compare outcomes in the domain of self-reported hearing handicap across groups of patients fit with one versus two cochlear implants (CI, CI + CI), or with an implant and a hearing aid (HA) in the nonimplanted ear (CI + HA).

Design: The design was retrospective, and a preliminary step was to factor analyze the two measures used, namely, the Hearing Handicap Inventory for the Elderly (HHIE) and the Hearing Handicap Questionnaire (HHQ). Longer versus shorter-term experience with a single implant profile was compared, and further analysis confined to patients fit for less than 100 mo across the three profiles. Pre- versus postimplant self-report and performance (speech test, localization) data were also compared.

Results: Three factors were identified in the HHIE, labeled Emotional Distress (HHIE), Difficulty in Hearing, and Social Restriction (HHIE). Highest handicap score for Emotional Distress (HHIE) was observed in the CI + HA group. There were significantly lower scores for Difficulty in Hearing in the CI + CI group than in the CI (p = 0.02) or CI + HA (p = 0.001) groups. On the Social Restriction (HHIE) subscale, the CI + CI group reported significantly lower rating than the CI (p = 0.009) or CI + HA (p = 0.006) groups. Two factors were identified in the HHQ, labeled Emotional Distress (HHQ) and Social Restriction (HHQ). Significantly higher Emotional Distress (HHQ) score was observed in the CI + HA group than in the CI + CI group (p = 0.002); significantly lower Social Restriction (HHQ) score was found in the CI + CI group than in the CI (p = 0.02) or CI + HA (p < 0.001) groups. Pre-post speech test performance showed least contrast in the CI + HA group.

Conclusions: Outcomes demonstrate an evident reduction from single or bilateral implantation in the area of emotional distress and a further advantage from bilateral implantation in the areas of hearing difficulty and social restriction.

Interaural Time and Level Difference Thresholds for Acoustically Presented Signals in Post-Lingually Deafened Adults Fitted with Bilateral Cochlear Implants Using CIS+ Processing

from Ear and Hearing

Abstract:
Objectives: The main purpose of the study was to measure thresholds for interaural time differences (ITDs) and interaural level differences (ILDs) for acoustically presented noise signals in adults with bilateral cochlear implants (CIs). A secondary purpose was to assess the correlation between the ILD and ITD thresholds and error scores in a horizontal-plane localization task, to test the hypothesis that localization by individuals with bilateral implants is mediated by the processing of ILD cues.

Design: Eleven adults, all postlingually deafened and all bilaterally fitted with MED-EL COMBI 40+ CIs, were tested in ITD and ILD discrimination tasks in which signals were presented acoustically through headphones that fit over their two devices. The stimulus was a 200-msec burst of Gaussian noise bandpass filtered from 100 to 4000 Hz. A two-interval forced-choice adaptive procedure was used in which the subject had to respond on each trial whether the lateral positions of the two sound images (with the interaural difference favoring the left and right sides in the two intervals) moved from left-to-right or right-to-left.

Results: In agreement with previously reported data, ITD thresholds for the subjects with bilateral implants were poor. The best threshold was ~400 [mu]sec, and only five of 11 subjects tested achieved thresholds <1000 [mu]sec. In contrast, ILD thresholds were relatively good; mean threshold was 3.8 dB with the initial compression circuit on the implant devices activated and 1.9 dB with the compression deactivated. The ILD and ITD thresholds were higher than previously reported thresholds obtained with direct electrical stimulation (generally, <1.0 dB and 100 to 200 [mu]sec, respectively). When the data from two outlying subjects were omitted, ILD thresholds were highly correlated with total error score in a horizontal-plane localization task, computed for sources near midline (r = 0.87, p < 0.01).

Conclusions: The higher ILD and ITD thresholds obtained in this study with acoustically presented signals (when compared with prior data with direct electrical stimulation) can be attributed-at least partially-to the signal processing carried out by the CI in the former case. The processing strategy effectively leaves only envelope information as a basis for ITD discrimination, which, for the acoustically presented noise stimuli, is mainly coded in the onset information. The operation of the compression circuit reduces the ILDs in the signal, leading to elevated ILD thresholds for the acoustically presented signals in this condition. The large magnitude of the ITD thresholds indicates that ITDs could not have contributed to the performance in the horizontal-plane localization task. Overall, the results suggest that for subjects using bilateral implants, localization of noise signals is mediated entirely by ILD cues, with little or no contribution from ITD information.

Multicenter U.S. Bilateral MED-EL Cochlear Implantation Study: Speech Perception over the First Year of Use

from Ear and Hearing

Abstract:
Objective: Binaural hearing has been shown to support better speech perception in normal-hearing listeners than can be achieved with monaural stimulus presentation, particularly under noisy listening conditions. The purpose of this study was to evaluate whether bilateral electrical stimulation could confer similar benefits for cochlear implant listeners.

Design: A total of 26 postlingually deafened adult patients with short duration of deafness were implanted at five centers and followed up for 1 yr. Subjects received MED-EL COMBI 40+ devices bilaterally; in all but one case, implantation was performed in a single-stage surgery. Speech perception testing included CNC words in quiet and CUNY sentences in noise. Target speech was presented at the midline (0 degrees), and masking noise, when present, was presented at one of three simulated source locations along the azimuth (-90, 0, and +90 degrees).

Results: Benefits of bilateral electrical stimulation were observed under conditions in which the speech and masker were spatially coincident and conditions in which they were spatially separated. Both the “head shadow” and “summation” effects were evident from the outset. Benefits consistent with “binaural squelch” were not reliably observed until 1 yr after implantation.

Conclusions: These results support a growing consensus that bilateral implantation provides functional benefits beyond those of unilateral implantation. Longitudinal data suggest that some aspects of binaural processing continue to develop up to 1 yr after implantation. The squelch effect, often reported as absent or rare in previous studies of bilateral cochlear implantation, was present for most subjects at the 1 yr measurement interval.

The Effect of Brief-Tone Stimulus Duration on the Brain Stem Auditory Steady-State Response

from Ear and Hearing

Abstract:
Objective: To investigate the effect of brief-tone stimulus duration on the amplitude of the brain stem auditory steady-state response (ASSR), both in single- and multiple-stimulus conditions.

Design: In Experiment 1, the primary stimuli were Blackman-windowed 500- and 2000-Hz brief tones presented using repetition rates of 79 and 83 Hz, respectively. Stimuli had durations ranging from 0.5 to 12 msec. In the single-stimulus condition, these two stimuli were presented dichotically, whereas in the four-stimulus multiple-stimulus condition, instead of being presented alone, each stimulus was combined with three interfering stimuli, which were also Blackman-windowed brief tones spaced one octave apart, and presented at rates of 77 to 96 Hz. In Experiment 2, the effect of brief-tone duration and the effect of interfering stimuli were further studied by systematically removing interfering stimuli from the multiple stimuli, with the goal of determining which specific stimuli in the multiple stimuli were responsible for the interference. In both experiments, stimuli were presented at 75 ppe dB SPL. The subjects were normal-hearing adults, who relaxed or slept during the recording sessions.

Results: Experiment 1: ASSR amplitudes increased as stimulus duration decreased in the single-stimulus condition, for both 500 and 2000 Hz. However, amplitudes did not significantly increase until stimuli were quite brief (2 msec for 2000 Hz; 6 msec for 500 Hz). In the four-stimulus multiple-stimulus condition, the pattern of amplitude increase with decreasing stimulus duration at 2000 Hz was similar to that in the single-stimulus condition, although amplitudes at all durations were reduced. However, for 500-Hz stimuli in the four-stimulus multiple-stimulus condition, ASSR amplitudes showed no change as stimulus duration decreased. Experiment 2: for 2000-Hz stimuli, the 4000-Hz interfering stimuli resulted in the largest change in amplitude, the 1000-Hz interfering stimuli had a small effect, and the 500-Hz interfering stimuli had no effect. For 500-Hz stimuli, the 1000-Hz interfering stimuli had the greatest effect, the 2000-Hz interfering stimuli the next largest, and the 4000-Hz interfering stimuli a small effect. The interference effects for 500-Hz stimuli occurred only for brief (<=6 msec) stimuli, with no effects of the interfering stimuli when the 500-Hz stimuli were 8 or 12 msec in duration.

Conclusion: Although brief tones may result in larger-amplitude ASSRs, their duration must be quite brief (not more than three to four cycles) to show a significant amplitude increase. Moreover, when presented together with other stimuli in the multiple-stimulus technique, response interference reduces the amplitudes of ASSRs, and for 500 Hz removes the amplitude gain normally seen with decreasing duration. Brief-tone stimuli, therefore, may not be optimal for ASSR threshold estimation, especially because of the compromise in frequency specificity accompanying the use of very brief tones.

The Influence of Different Speech Processor and Hearing Aid Settings on Speech Perception Outcomes in Electric Acoustic Stimulation Patients

from Ear and Hearing

Abstract:
Objective: Electric acoustic stimulation (EAS) is an increasingly popular means of treating individuals with a steeply sloping mid-to-high frequency hearing loss, who traditionally do not benefit from hearing instruments. These persons often have too much residual hearing to be considered for a cochlear implant. Several studies have demonstrated the ability both to preserve the remaining low-frequency hearing in these individuals, and to provide significant benefit through combining a cochlear implant with a hearing aid to amplify the same ear. These improvements in performance have been especially noted in noise. Often overlooked is that these outcomes may be influenced by the fitting parameters of both the cochlear implant and the hearing aid.

Design: This study assessed four EAS subjects, with a minimum of 1 month’s EAS use, on eight different fitting parameters. Sentence testing in different noise levels (+15, +10, and +5 dB SPL) was conducted. Subjects also evaluated each condition using a visual analogue scale.

Results: Results demonstrated that a reduced overlap of cochlear implant and hearing aid amplification produced best results across listening conditions.

Conclusions: The hearing aid should be fit to a patient-specific modified audiogram at least up to the point where low-frequency hearing is not measurable. The cochlear implant should be fit from a higher frequency point than is standard in patients without residual hearing in the implanted ear, to provide reduced overlap with the amplification provided by the hearing aid. Therefore, a small amount of overlap between the frequency ranges used by the hearing aid and the cochlear implant seems beneficial.

Universal Newborn Hearing Screening: Parental Reflections on Very Early Audiological Management

from Ear and Hearing

Abstract:
Objective: This article seeks to understand very early audiological management from a parental perspective, after the early identification of their child’s hearing loss through universal newborn hearing screening (UNHS).

Design: Data are taken from the national evaluation of the introduction of UNHS in England. Forty-five parents and caregivers participated in a qualitative, narrative study within which they identified key challenges generated by the audiological management of very young babies with hearing loss at home.

Results: Concern centered on the virtual timetable constructed by parents after screening, the practical daily management issues and the need to establish infant rather than a child focus in audiological practice. In addition, specific challenges relating to moderate hearing loss were identified.

Conclusions: Results are of particular relevance to pediatric audiologists, teachers of the deaf * and those offering early intervention services.

Active Noise Reduction Audiometry: A Prospective Analysis of a New Approach to Noise Management in Audiometric Testing

from Laryngoscope

Abstract:
Objectives: To develop a new method of screening audiometry that reduces the adverse effects of low frequency background noise by using active noise reduction (ANR) headphone technology.

Design: Prospective testing within an anechoic chamber evaluated the physical properties of ANR headphones. A prospective clinical crossover study compared standard audiometry with ANR headphone audiometry.

Methods: Bose Aviation X circum-aural ANR headphones were tested for both active and passive attenuation properties in a hemi-anechoic chamber using a head and torso simulator. Thirty-seven otology clinic patients then underwent standard audiometry and ANR audiometry, which was performed in a 30- and/or 40-dB sound field.

Results: Objective ANR headphone attenuation levels of up to 12 dB were achieved at frequencies below 2,000 Hz. In standard audiometric testing, 40 dB of narrow-band background noise decreased patient pure tone thresholds by 24 dB at 250 Hz. The use of ANR technology provided 12 dB of additional attenuation. This resulted in a significant improvement in test results despite the 40 dB of background noise (P = <0.001). In a 30-dB sound field, standard audiometric thresholds were shifted down by an average of 12 dB. The use of ANR technology completely attenuated this effect and resulted in a significant improvement in results (P = <0.01). These results were identical to those obtained in a quiet sound booth.

Conclusions: Despite a 30-dB sound field, ANR audiometry can produce an audiogram identical to that obtained in a double-walled sound booth. ANR headphone audiometry improves the sensitivity of audiometric screening for mild low-frequency hearing loss. This technology may have important applications for screening in schools, industry, and community practices.