Something happened today that provided me with inspiration for this blog post. Aiden, my 3 year old son with ASD, wanted to play his video game. I know, most parents would refuse to let their child play video games at this age, but Aiden is not a typical child and I am not most parents. So, after completing his learning activity for the day I allowed him to get on the game. He loves to play Lego Marvel Superheroes. Aiden can turn on the Xbox and TV by himself, sign in, and start the game all on his own and has done so many times. This time Aiden pulled the TV remote out and placed it on the table. Evidently he forgot that he had done this because I observed him searching for the remote, after he turned on the Xbox.
That is where the problem began. I told Aiden four or five times the remote controls location, but it did not stop his search for the right remote. I caught myself getting frustrated and by the fourth time I was barking the same statement at him. It seemed to finally click. He grabbed the remote, sat down, and started playing his game. I sat and thought to myself, why was that so hard. I remembered my brother struggling with the same behavior as a kid. My mom used to make him look at her and she would repeat the instructions twice and then make him repeat what she said. This is not the first time I have seen this behavior in Aiden and I'm surprised it is the first time I have picked up on it. I know Aiden can hear. He demonstrates his hearing ability very well; even when he is playing his video game he will do what he is told, without repetition of the command. So what is it?
This question sent me on a crusade to find an answer.
Selective hearing is a common problem in Autism from what I have found. First let’s briefly explore how we hear.
Did you know that your ear is the only mechanical sensory organ in your body? Weird, but all the other senses require chemical reactions to happen, but not your ears. When sound reaches your ears it is caught by the pinna, that is the outer most part of the ear that you see. It’s the part we pierce and strap our ear buds to. There you learned at least two new things today, I know I sure did. So the pinna funnels the sound into your outer ear and down the ear canal to the ear drum. The ear drum vibrates as the sound passes into the vestibule and cochlea. The cochlea forces the sound through liquid for the first time. The small bones in your inner ear (yes there are tiny bones deep in your ear) amplify the sound. The cochlea translates the vibrations into electrical impulses that the brain decodes. Cool huh?
That is where the problem began. I told Aiden four or five times the remote controls location, but it did not stop his search for the right remote. I caught myself getting frustrated and by the fourth time I was barking the same statement at him. It seemed to finally click. He grabbed the remote, sat down, and started playing his game. I sat and thought to myself, why was that so hard. I remembered my brother struggling with the same behavior as a kid. My mom used to make him look at her and she would repeat the instructions twice and then make him repeat what she said. This is not the first time I have seen this behavior in Aiden and I'm surprised it is the first time I have picked up on it. I know Aiden can hear. He demonstrates his hearing ability very well; even when he is playing his video game he will do what he is told, without repetition of the command. So what is it?
This question sent me on a crusade to find an answer.
Selective hearing is a common problem in Autism from what I have found. First let’s briefly explore how we hear.
Did you know that your ear is the only mechanical sensory organ in your body? Weird, but all the other senses require chemical reactions to happen, but not your ears. When sound reaches your ears it is caught by the pinna, that is the outer most part of the ear that you see. It’s the part we pierce and strap our ear buds to. There you learned at least two new things today, I know I sure did. So the pinna funnels the sound into your outer ear and down the ear canal to the ear drum. The ear drum vibrates as the sound passes into the vestibule and cochlea. The cochlea forces the sound through liquid for the first time. The small bones in your inner ear (yes there are tiny bones deep in your ear) amplify the sound. The cochlea translates the vibrations into electrical impulses that the brain decodes. Cool huh?
The Listening Center published an interesting article about Listening Training for Children with Autism that was presented at the 2004 AutismOne Conference. The researcher told a story about one mother's frustrations with her child's inability to hear, which prompted a hearing test that the child passed. As any parent would be at this point she did not know what to do. The researcher explained four critical areas of hearing: attuning, protection, the ear of the body, and the ear and the voice.
Attuning is the listening ability that allows us to focus on the sound messages we need and leave out the ones we don't. This function is a large part of the receptive language function of our auditory process and is a struggle for those with Autism.
Protection is the process in which we tune out background noise, and is something that individuals with Autism struggle with, especially children. Since those with Autism cannot selectively block out what they do not want to hear they block out everything, which is a barrier we have to penetrate in communication.
The Ear of the Body makes reference to the other operating systems the ear controls. The ear also controls balance, sense of space and gravity. The function of the ear also controls a base for our body image awareness and motor planning. There are theories that in order to communicate with other people we must first be able to communicate with ourselves. This theory drives the explanation that those with Autism cannot communicate with themselves due to a break down in the ear of the body process and that contributes to the lack of communication.
The Ear and the Voice represents a breakdown in the ear-voice feedback loop. When you talk you hear your own voice. Researchers theorize that when a child with Autism speaks they are unable to control the way their voice presents itself, loud or soft, course or gentle, etc. Therefore the individual with Autism will not recognize the voice they hear, despite making the voice themselves. This causes a breakdown in communication.
Does this mean our children with Autism can't hear? No. Not at all. In fact they prove to us time and again they are listening. It seems with our children selective hearing strikes more frequently due to sensory overload.
I read a 2009 article from Positively Autism, written by a school teacher who specializes in Autism. She tells the story of a teacher in the first grade reading The Wolf and the Goat from Aesop's fables. One of the children listening to the story is Autistic. He seemed to look around the room and briefly at the teacher. His behavior during the story would indicate that he was not listening. So the teacher called on him and asked if the wolf saw a goat, to which the child repeated the word goat. Now we are all very familiar with echolalia in Autism. So the teacher asked the students to draw a picture in their journals about the story. She went over to the child with Autism and asked if he wanted to draw a goat or a fox. The little boy looked at her strangely and said "No. Wolf". The teacher had not realized her mistake in changing the fox to a wolf in her question and knew then that the little boy was in fact listening to her story. With no prompting the boy drew a picture of the wolf and the goat in his journal.
So if they are listening, then what can we do to help them listen better? Well, that answer is not so simple. In my search I also read a 2013 article from SFARI about listening devices helping children with Autism. It cites a study that found 6% of children with hearing problems also have Autism, compared with 1% of the general population. It also cites an October study in the Journal of Pediatrics found that wireless radio frequency listening device helps children with Autism hear teachers talk and may improve their social interactions and learning. This system requires the teacher to wear a small microphone on their lapel, which transmits their voice to the student's ear piece. Teachers in this study reported a significant positive change in the child's behavior and were more attentive. If your child can ear headphones, it is probably a good indication that this system will work for them, but children who do not like the feel of the earpiece may need to practice with it or find alternatives.
Other alternatives can include written instructions to supplement oral instructions for activities or picture boards depicting the order of the instructions. For serious concerns please consult an audiologist or an Ear, Nose and Throat doctor (ENT) to rule out hearing loss. You may also consider listening training. There are many types of listening training programs available. Please consult your therapy team for their recommendations.
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