knowing when to refer: how audiologists can help with early screening for autism spectrum disorder...
TRANSCRIPT
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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
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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
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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
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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
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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
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The Electronic Library
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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
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Modules in the Electronic Library
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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
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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
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Sample Module
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2015 EHDI Conference
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Future Directions• Feedback from audiologists
• Complete remaining modules
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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.
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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
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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