Autism Spectrum Disorder: Early Identification

Dr. Traynor published this innovative finding at Hearing Health and Technology Matters, October 5, 2016.  It suggests that Otoacoustic emissions might be an essential component of the early Diagnosis of Autism Spectrum Disorder. 

According to the National Institute on Neurological Disorders and Stroke (NINDS) (2016), Autism Spectrum Disorder (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction.  A diagnosis of ASD now includes several conditions that use to be diagnosed separately:  Autistic DisorderPervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), and Asperger Syndrome.  The term “spectrum” refers to the wide range of symptoms, skills, and levels of functional disability that can occur in people with ASD.  There is often nothing about how those with ASD look that sets them apart from others but they may communicate, interact, behave, and learn in ways that are quite different from most other people and may be severely challenged or extremely gifted intellectually.

The symptoms of ASD are present from early childhood and affect daily functioning in the ways in which these individuals learn, think, and problem solve.  Some of these individuals require a lot of assistance in their daily lives and others need no assistance.  While boys are significantly more likely to develop ASD than girls, currently the Centers for Disease Control and Prevention (CDCP) estimate that 1 in 68 children has ASD and it occurs in every socioeconomic, racial and ethnic group.  Although many signs of ASD are present before age two, the majority of children with ASD are not diagnosed until after age four, which means that corrective therapies are started later, delaying their potential impact.  NINDS states that twin and family studies strongly suggest that some people have a genetic predisposition to autism.  Identical twin studies show that if one twin is affected, then the other will be affected between 36 to 95 percent of the time.  There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD.  In families with one child with ASD, the risk of having a second child with the disorder also increases.

Signs and Symptoms

People with Autism Spectrum Disorder often have problems with social, emotional, and communication skills.  Many people with ASD also have different ways of learning, paying attention or reacting to things and they often repeat certain behaviors.  Signs of ASD begin during early childhood and typically last throughout the person’s life.  The CDCP (2016) indicates that children with ASD demonstrate some or many of the following behaviors:

  • Do not point at objects to show interest.
  • They do not look at objects when someone points them out.
  • They have difficulty relating to others or do not have an interest in other people at all.
  • In personal interactions, they avoid eye contact.
  • They have extreme difficulty in appreciating other people’s feelings or discussing their feelings.
  • Prefer not to be cuddled or might cuddle only when they want to.
  • They appear to be unaware when people talk and interact with them but respond to other sounds in the environment.
  • Are very interested in others, but have difficulty talking, playing, or relating to them.
  • In place of normal language, they repeat or echo words or phrases presented to them.
  • It is difficult for them to express their needs using typical words or motions.
  • They do not play “pretend” games.
  • They repeat actions over and over again, such a turning on/off light switches and other perseverative behaviors.
  • React unusually to the way things smell, taste, look, feel, or sound.
  • Once learned, they lose skills they once had (e.g., stop saying words they were using).

There may be early signs of the ASD, according to the NINDS (2016) such as:

  • The child does not babble or point by age 1.
  • There are no single words by age 16 months or two-word phrases by age 2.
  • They do not respond to their name.
  • They excessively line up of toys or objects.
  • The child does not smile or demonstrate social responsiveness.

Treatment of ASD

Currently, there is no cure for ASD.  There is, however, good evidence that early intervention treatment services can improve the child’s development.  From our background in hearing impairment, audiologists and other professionals know that early intervention services from birth to three years of age is when children learn important skills.  Therapeutic services can assist the child in walking, talking, and interacting with others and it is beneficial for ASD children to obtain these services as soon as possible.  There are services in many countries for ASD, but it may not be referred to by that terminology.  It may be signified as speech-language delay or late development (walking, etc.).  Services are often sought for these conditions when ASD has not been specifically diagnosed.

New Research for Early Intervention in ASD

As presented earlier, many signs of ASD are present before the age of two but the majority of children are not diagnosed until about age four, delaying and possibly reducing the benefit of therapeutic intervention.  Dr. Loisa BennettoJessica Keith, Dr. Paul Allen and Dr. Ann Luebke, researchers at the University of Rochester (USA), have identified an inner ear deficiency in children with Autism that may impact their ability to recognize speech.  Their findings, published in the July 2016 issue of the journal of Autism Research, could ultimately be used as a method of identifying children at risk for autism at an early age.  Their interest was to study if otoacoustic emissions (OAE) in ASD children with normal hearing thresholds were different than normal hearing children without ASD.  They measured distortion product otoacoustic emissions (DPOAE) and transient evoked OAEs (TOAE).  Their study involved 35 high functioning ASD children and 42 control subjects all males aged 6-17 years of age with normal routine audiometric findings.  While there was no significant differences found in DPOAE or TOAE noise floors, middle ear muscle reflex activity or efferent suppression; the ASD children had greatly reduced DPOAE responses in the 1 kHz frequency range while having responses similar to the control group .5 and 4-8 kHz.  Additionally, analysis of the spectral features of the TOAE waveforms for the ASD children demonstrated significantly reduced emissions in the same frequency region as the DPOAEs.  The group concluded from their research that attention to specific-frequency deficits using non invasive OAE techniques to measure cochlear function may be important in the auditory processing deficits found in children with ASD.  Once this procedure is known and available to audiologists as a clinical technique that can be used to diagnose ASD, it could be of great benefit worldwide in obtaining assistance desperately needed by these children at a very early age.


Bennetto, L., Keith, J. Allen,P & Luebke, A. (2016).  Children with auditory spectrum disorder have reduced otoacoustic emissions at 1 kHz mid frequency region.  Autism Research, doi:10.1002/aur.1663.  Retrieved October 5, 2016.

Michaud, M. (2016).  Hearing Test may identify autism risk.  University of Rochester Medical Center.  Retrieved October 5, 2016.

National Institute on Neurological Disorders and Stroke (2016).  Autism Spectrum Disorder Fact Sheet.  Retrieved October 4, 2016.

Traynor, R. (2016). Autism Spectrum Disorder:  Early diagnosis.  Retrieved December 5, 2018.

Images: (2012).  1 in 88 US children have autism spectrum disorder.  Retrieved October 5, 2016.

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