Many individuals with autism spectrum disorders have difficulty processing auditory information. Research has revealed that there are significant impairments with how the brain processes auditory stimulus, particularly with millisecond delays of sound processing, inability to perceive the meaning of sounds, as well as deficits in storing and retrieving auditory information from working or long-term memory. As parents, we can all think of examples in our children with ASD that fit these patterns. For example, my son Sam, as well as many of my clients, has tremendous difficulty understanding prepositions (on, under, in the middle) and “wh” questions. These are transient concepts that appear to be difficult to get into the long-term memory. Additionally, “who, what, where, when,” and “why” can all sound very similar to someone with a severe auditory processing disorder.
Auditory Processing is very complex, and with individuals on the spectrum, multifaceted. Individuals with a diagnosis of ASD can have a broad variance of characteristics that are associated with auditory processing disorder. My experience as a mother and a speech pathologist has convinced me that most individuals on the spectrum have some level of challenge with auditory processing. These challenges are broad and can range from mild to severe in impact. Research has shown that the hippocampus, which is located in the limbic system, is neurologically immature in individuals on the autism spectrum (Bauman & Kemper, 1994). This area of the central nervous system is responsible for sensory input as well as learning and memory (ARI, Edelson). Continued research will help us learn more about how to facilitate learning auditory information and hopefully, lead to treatments for underlying causes.
It is interesting to note that one study found that individuals on the spectrum who do not have auditory processing problems did very well using the Applied Behavior Analysis approach, but that individuals with auditory processing challenges did not do as well with ABA (McEachin, Smith and Lovaas, 1993). For individuals with visual strengths, a visual communication/instruction approach might work best. Incorporating more visuals into an ABA program also helps internalize auditory information.
I have worked with some clients on the spectrum who respond very similarly to individuals who have a moderate to severe hearing impairment. These individuals need a lot of contextual cues and visuals (picture/printed words) paired with meaningful activities that incorporate practice to map meaning onto sound. As young children, these individuals often lack critical communication and symbolic skills because the severity of their processing impairs their ability to get meaning from language and their environment. There are other individuals who understand some concrete, functional or personally meaningful aspects of language and communication from a young age, but frequently seem to miss the meaning of some sounds, words and/or abstract language. These individuals, who often have more symbolic language skills than the more challenged group also benefit from similar strategies, but also need more strategies incorporated into learning social routines such as how to initiate, respond and maintain a conversation. They may also need strategies for handling communications that are unclear.
I have mentioned just a little about the neurological basis for auditory processing disorders that we see in ASD. There is also the attention aspect of auditory processing, which is likely also rooted in neurological development.. Many individuals on the spectrum are just not wired to be interested in or learn about important information. With some individuals this may be cause and effect and with others it seems like they co-exist. This would be another aspect to study.
It is important to understand that auditory processing is very likely impaired to some degree in most individuals on the spectrum. We need to understand that behavior can be the result of not being able to understand what is being communicated, frustration with not being able to retrieve information to communicate, or can be frustration with expectations that are not personally meaningful. So it is very important to identify the best way to teach someone new information based on their individual processing abilities. We need to also make sure that an appropriate communication system is in place based on the unique needs of each individual. As a person with ASD matures, we need to help them reach each new level of communication to their greatest potential, whether that is with using a dynamic display device or whether that is maintaining an appropriate verbal conversation.
Anne Bramlett, MS, CCC/SLP
Speech and Language Services of North Texas