Effective management of auditory differences in
people with autism
The content of this document is OFFICIAL. Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making.Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters, they are to call the TAPS line for advice.The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters
Research questions:
- For people with autism and normal hearing who experience decreased sound tolerance::
- Does use of sound reduction or exclusion devices or strategies result in permanent, long-term improvements in sound tolerance or functional listening skills? And how do improvements compare to:i.improvements as a result of normal developmentii.sound desensitization or other psychotherapy?* What is the risk of using sound reduction or exclusion devices leading to increased sensitisation and worsening DST? What therapies exist for DST (deafness) support therapy)? For those experiencing deficits: - In functional listening skills or auditory processing does use of sound-reduction or exclusion devices lead to lasting improvement compared no treatment at all?
Contents
Effective management of auditory differences in people with autism ……………………………….
Summary
This paper concerns treatments and management methods used when dealing with hearing-related issues among individuals diagnosed as autistic. The text discusses various techniques like Frequency Modulation systems, sound exclusion/reduction measures,,and therapies aimed specifically towards improving communication skills within these populations.
Research paper
OFFICIAL For Internal Use Only
strategies. Evidence base focusing on people with autism is minimal for most interventions.“Clinicians warn against overuse ear protection devices avoidance strategies as this exacerbate symptoms”of sound intolerance However “sound exclusion reduction strategies still be used if they form part gradual desensitisation program” In case of auditory processing difficult FM systems effective children autistic improving listening classroom though results mixed There also evidence increase listening effort while using device Further detail refer TRT research papers RES_153_and_RES_153a Treatment approaches include training music therapy Though evidence population limited study quality amount research Both DST and auditory processing difficulties long term outcome no treatment unclear Some suggests reduce age terminology There inconsistency literature use terminology referring sensory processing associated symptoms conditions further discussion section Theoretical terminologies_in RES Sensory-based Therapy Also true more specifically auditory processing sensitivities Henry et al de Wit et al Sound intolerances understood different frameworks Example terms hyperacusis decreased sound tolerance sometimes synonymous Williams et al And sometimes treated specific type DST Timms et al purposes paper Decreased sound tolerance refers group condition reduced hearing Hyperacusism misophonia phonophobia Timms et al Auditory processing difficulties behaviours functional concerns result differences central auditory system not damage or impairment peripheral audi Difficulties slow inappropriate responses difficulty noisy environments attention following instructions learning reading spelling localising Aristidou Hohman American Academy Audiologists hypersensitivity refers heightened sensitivity sounds Symptoms may lead diagnosis Other key definitions are: auditory differences autism
- Hyperacusis is the experience of pain or discomfort at everyday sounds at volumes that would not trouble most people Williams et al., 2021a. Misophonia is a strong negative emotional physiological behavioural response to specific sounds regardless loudness Trigger sounds often but always repetitive bodily like chewing slurping sniffing breathing Swedo et al.. Phonophobia fear Specific sounds usually associated anticipation will cause pain comfort exacerbate existing condition Henry et al…Auditory Processing refers contribution central auditory nervous system receiving stimuli mediating responses Mansour et al….Aristidou Hohman… APD disorder AUDITORY PROCESSING DIFFICULTIES REACH SOME DETERMINED CLINICAL THRESHOLD Aristidou & Hohman…, Audiology Australia,…Autism and auditory Differences The latest edition Diagnostic Statistical Manual DSM includes sensory features diagnostic criteria Autism Spectrum Disorder states restricted repetitive patterns behavior interests activities manifest as:Hyper- hyporeactivity Sensory input unusual interest aspects environment apparent indifference temperature adverse response specific sound textures excessive smelling touching objects visual fascination lights movement American Psychiatric Association, pp57–58.Increased sensitivity processing issues common autism Studies suggest up autistic reactions sensory stimul Deng Scheerer Ocak Robertson Baron Cohen Auditory differences characterised differently literature Researchers professional organisations disagree APD cooccur with autism whether difficulties are symptoms of itself (Aristidou & Hohman de Wit Brout Ocak 2018;American Academy of Audiology). Furthermore APD produce intolerance to sound Ferrer Torres Giménez-Llort blurring lines between APD DST conditions distinct entities Some researchers place causes in the auditory processing system though subgroups hyperacusis misophonia phonophobia may have different
Research paper
OFFICIAL For Internal Use Only causal factors including neurological or psychiatric factors ( Ferrer-Torres & Giménez-Llort, timms et al., timms et al.; Williams et al; Brout et al. in addition some researchers focus over responsiveness under-responsiveness These auditory differents overlap but do not strictly map onto symptoms either APD hyperacusis misophonia phonophobia Yuan et al restrictive repetitive patterns behaviour can present as extreme adverse responses sounds American Psychiatric Association Studies estimate prevalence Hyperacousis Autism populations anywhere between 18%69% danesh et al One study found %of autistic diagnosed Misophonia Jager et al Regarding Phonophobia up to may have fear aversion Sounds though unclear if these would meet diagnostic threshold Phonophobia no available estimates coincidence ASD combined hyperacusis misophonia phonophobia studies also shown high frequency processing difficulties people with autism Ocak Mansour Jones Prevalence studies indicate hearing impairment more common Autism population general population Bougeard et al reviewed three prevalences found estimates of %4.% largest Scottish study over participants Hearing Impairment times prevalent in Autism compared General Population Rydzewska et al Treatments and management strategies Frequency Modulation systems TRT research papers RES 153 and RES review literature use FM Systems for People With Autistic And Apd Please refer these Papers More Information previous Research evidence that Use Of Fm System Can Improve Listening Auditory Performance Communication Speech Recognition Noise On Task Behaviours Auditory Filtering Effects noise reverberation Averseness Sound However effects based on significant issues quality low levels Evidence further Study related the use fM system published since last Review Feldman et al conducted a study remote microphone system young Participants listening-in-noise accuracy improved all while effort increased average below nonverbal cognitive ability language reduced audio-visual integration Auditory differences In Autism Page:Page
Research paper
OFFICIAL For Internal Use Only
A connection proposed by Schafer et al (2020a)
was not considered in TRT’s previous reviews.
The authors refer to previous studies showing that auditory processing
differences present similarly in children with autism and other neurological\nor development concerns,
such as ADHD and APD.From this hypothesis interventions which support people
w ithAPD may address auditory processing concern sin children w i thautism.As such it m ay be possible
to suppor tthe use o fFM systems for peopl ewith aut ismby appealto them ore robust evidence base \forth u seof FM system sf orpeoplew ithA PD(without diagnosed autism).This includes a 2016 systematic reviewand anumberor randomised controlled trials.Reynoldset al(2016)r eviewe d7 publications investigatingtheroleoffMsystemsin heclassroom.They found moderate evidencethatF Msys temuseimproveslistening anda ttentionintheclass room.Theev idence was mixed inorderrelationtointerventionsofspecificacademicareas.Morer ec entlyStavrinosetal(2022)conductedanRCTwit h26childrenwi thAp Dando therdevelopmentalorneurol ogicalcondition.T hes tudies focus onpossible benefits of regular us eof the FMs ystemon unaided listeninga ndattention skills. The authorsfound no significant improvements toun aid edlisteninganda ttentionskills They did find
improv ements in classroom list ening based children’s responses
toa shortened version oft heLIFE-Rquestionnaire.Nobehaviouroraludiologica ltestsw ereperformedtoastess listen ingora ttent ionsk il lswhileusingtheFMdevice.
While existing studies show positive results,themost robust findings arefor populationswithoutautism.There is some evidence that FM systemsare effective for chil drenwith autismin improvinglisteningsnth e class ro om thoughresults a remixedand thereis also evidentefor an increase int eachningeffort while usingthedevice.
Individual factors may determine theefficacyofAFMsystem.For example som e autistic participantsint hereviewe dst udieswere not abletolerate devic due tod i scomfortorsensoryissues.This suggests strategiesthat do n otinvolveearw orn devicesmay bemore accepted.F orexample recent systematic review into use o fsoundfield amplification systemsin primary school settingshowbenefitsf orspeech perceptionlistening comprehension and auditory analysis language outcomes academicoutcomes anda ccomport(Mal ling 2016).Considering sensory processing m ay affect all studentsintheclassroom (Mal lor y& Keehn ,20) sound fieldamplific ation sys tems ma be desirable as they can benefit the entire classroom without singling outan individual with adiability
5. Sound exclusion reduction A common strategy to manage DST avoidance of offendingsound This might mean personremoves themselves from noisy environments avoids environment expectto b enoisy.Itcan alsomeantheuse assistive technology modifications reduce excludeoffending sounds.Suchassistivetechnologymight include noise cancelling headphones earmuffs ear plugs, sound absorbing material on walls curtains carpets.In a survey
two hundred fifty five speech therapists audiologists teachers graduatestudents Neave diToro et al(2021)foun dat almost half respondents had recommended ear worndevices
Research paper
OFFICIAL For Internal Use Only to their clients with autism. Scheer et al (2022) found around half of parents surveyed had used ear-worn devices to reduce sound exposure, while half of those parents were satisfied with this strategy; Pfeiffer et al (2019a) suggests that both teachers and parents generally support using headphones during class time; Smith et€al (2022), however, indicates patients suffering from misophonia are more inclined towards wearing earwires than undergoing active treatment methods for managing symptoms related specifically thereto. The guidelines on classroom design recommend incorporating noise reduction materials into educational environments aimed at enhancing learning experiences across all students’ demographics (Kulawiak & Mallory, Keehn). Potential benefits associated directly or indirectly with employing such technologies include:
- improved comfort
- enhanced focus levels
- reduced perception of aversive sounds
- decreased occurrence rates concerning problematic behaviors
- increased engagement in social activities within communities
- minimal cost considerations when compared against other alternatives like hearing aids. There is a substantial body of research indicating the efficacy thereof regarding reducing anxiety, stress-related issues while simultaneously improving attention spans amongst children diagnosed as having Autism Spectrum Disorder (ASD). One study noted how implementing acoustic barriers significantly boosted autistic individuals’ interaction capabilities among their peers (Mallory & Keehn); yet these findings remain largely confined to single-case studies due primarily owing insufficient sample sizes. Accordingly, it appears necessary further investigation should be conducted before drawing definitive conclusions about whether integrating sound-cancelling headsets could indeed constitute an evidence-based practice suitable for application inside classrooms; as per Kulawiak’s analysis. Additionally, a number of potential drawbacks exist pertaining exclusively toward excluding certain auditory stimuli altogether including but not limited to discomfort experienced by those wearing earwires; difficulty comprehending spoken language content; hindering linguistic development processes; limiting opportunities for meaningful interpersonal exchanges; stigmatizing affected students publicly; and last but certainly not least - financial burdens especially related specifically thereto involving home modifications required therein.
- dependence on device / increased sensitization (Danesh etal., 2021; Neave-diToro et al.,2021 Kulawiak*, 2021* Mallory & Keehn**, 2021) Agency. Regarding the last point, there appears to be consensus that the goal for the clinician should be desensitization of the patient’s auditory system and that overprotection due to the use of noise reducing or excluding technology may eventually cause harm (Henry etal., 2022).However, this does not mean that any use of ear-worn devices or sound-reducing environmental modifications doing avoided For example noise-cancelling headphones may part gradual process de-sensitization.For people autistic Danesh etal. (*2021) recommend: … it is important to desensitize an child with hyperacusis sounds reduce unnecessary protection as help symptoms rather than tackling sensitivity However this desensitization done more tact gradually timeline Autistic children need initially protect themselves against hyperacusis noise cancelling head phones later working closely parent clinicians can start implement desensitization (p.551). For general population Henry et al ( extbf{2022}) recommend: Patients aware loud sound damage exacerbate [the patients] sound tolerance condition necessitating appropriate hearing protection They also understand however inappropriate” use hearing protection can their sound-tolerance condition Some patients use because believe certain sounds will tinnitus or sound tolerance condition worse Need educated overuse result heightened sensitivity perception occlusion effect … If such has occurred then important take steps reverse by gradually reducing using hearing protection These must progress point only they use when exposed system (Henry et al., extbf{2022}, p. extbf{ extcolor{red}{5}})
Therapies: Recommendations for treatment DST include habituation training cognitive behavioural therapy dialectical behaviour therapy and tinnitus retraining therapy Danesh etal. (** extbf{2}*** 2021) suggest cognitive behavioral therapy habitation proven effective in the treatment of hyperacusis Henry etal. (2022) note that treatment usually involves element exposure counselling to address anxiety avoidant symptoms Exposure element implemented ear-worn devices headphones or hearing aids which gradual increase aims at desensitisation Nolan etal.(***** extbf{2} extbf{} 2020*) conducted retrospective study with
Research paper
OFFICIAL For Internal Use Only tinnitus, 50 of whom also had hyperacusis. They found that CBT with components of musical therapy, different relaxation techniques, and directed attention could significantly reduce symptoms of tinnitus, hyperacusis and associated psychological symptoms such as depression. They suggest that further research is needed to demonstrate the efficacy for patients with hyperacusis alone. Misophonia can also be treated with cognitive behavioural therapy, though there is less evidence of its efficacy (Henry etal.,). In the first randomised controlled trial for the treatment of misophonia,Jager etal.(), Jager et al (2020) found 10 of the 27 subjects in the treatment group improved significantly with cognitive behavioura ltherapyandthe results weremaintained after one-year follow up.Other psychotherapiesthat targetassociatedsymptomsofmisophoniasuchas anxiety or obsessive-compulsive symtoms mayalsobeeffective(Henry etal.[ ]{:(}#[ref-Henry-et-al-2022])Ferrer-Torres & Giménez-Llort,(][#ref-FerrerTorres-GimenezLlorrt-2022))As fear isthe main component of phonophobia,counselling such as therapies already mentionedmay assist to decouple sounds and negative associations((Henrey etal,)(]][#ref-Henry-et-al-2022]). Evidence is less reliablefor these therapiess for peoplewith autismwit cooccurring sound tolerance conditions(Zai *[et]*al,; Ferrer Torres&Gimenez Lloret(]([https://doi.org/10.34856/ejapa.92]{:target=“_blank”})[)](#ref-FerrerTorres-GimenezLloret-2022; Williams et al., 2021b Danesh et al.(2021 Brout et al (2018). Yuan et al ([2022) suggest that cognitive behavioural therapyis effectiveforgeneralsensory sensitivities inpeople withautismbut does not address specific issues wit hsound intolerance. treatment central auditory processing problems can include musictherapyauditory trainingandcognitivebehaviouraltheryHowever the evidenceof effectivenessin an autismpopulation minimalstudies using small sample sizes non controlled designs(Moossavi & Moalemi,(][#ref-MoossaviMoalemi-2021)). In acontrolled trial Ramezani etal [ ]{:(}#[ref-Ramezani-et-al-2021])Ramezani et al, found improvements speech perception group of young peoplewith autism after audiotyprocessingtraining for six weeks For general population Audiology Australia’s clinical practice guide (2022 recommendsmusictherapyauditorytraingfor treatmentcentral APD.Early evidenceshow some support efficacy audi tary trainginggeneralpopulation though quality and level evide nce significant limitation(Murphy Schochat(). A 2021 systematic reviewfound positive correlation between auditry procss skills musical ability More specifically authors find that months to yearsmusicaltrainingscan improve behaviourspeech in noiseperception children Braz etal.(](#ref-Braz-et-al-2021))One study suggests severity auditory processing symptoms decreases with age(Schafer et al.,)(]][#ref-Schaefer-et-al-2020b). Auditory differencesinautism Page 9of 14
References
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onumber \[5em]{ extbf{Mednicoff, S.D., Barashy,S., Gonzales,D,Benning.SD,,Snyder,J.S.&Hannon,E.E.(2022)}}& extit{(Auditory affective processing,musicality,andthe development misophonic reactions)} ag{}
onumber & extit{Frontiers in Neuroscience} ag{}, extit{16}, $oxed{}$ extit{$^,$ $^{9}{{2}4806$. }} ag{}
onumber
onumber&&https://doi.org/ extcolor[rgb]{0,.5,…:fnins}.2022.$^oxplus_lacksquare${24806}[3cm]&Moossavi,A,& Moallemi,M. times{}$$egin{array}{l} 2019) imes t(${10) ,}& oxplus_$-$$^,$^-{7}$ .$ ag{},Clinicss/2013($10)){12}\Neave-DiToro,D,Fuse A.& Bergen.M,(2021). extit{(Knowledge awareness ear protection devices sound sensitivity individuals autism spectrum disorders)}.Language Speech Hearing Services in Schools $52 $( ext{)},-$- rac{-}{+}-{2}. $ ag{}
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ightarrow t(, ext{11)}}$oxed{$^lacksquare_lacktriangledown${fpsyt 2020.}{0}{{0}}}
olimits& Ocak,E.,Eshraghi R.S Danesh,A,Mittal,R.Eshraghia.aA (2018) extit {(Central auditory processing disorder individualswithautismspectrumdisorders)} Balkan Medical Journal$^{},,${}$-{ extstyle{367}-{372}}} . ag{}
onumber&&https://doi.org/{balkanmedj }.2018.4}\Pfeiffer,B.,Erbsr.& Slugg,L,(2019). extit{(Impact noise attenuating headphones on participation home community school children with autism spectrum disorders)}.Physical Occupational Therapy in Pediatrics,$ imes$(,),-$- rac{-}{+}-{6}. $ ag{} && https://doi.org/ times {} ${OccupationalTherapyPediatrics}, {39( ext{)},~^{6}}{{7}}$.[ex] Pfeiffer B Stein Duker L Murphy A Shui C.(2019).Effectiveness ofnoiseattenuatingheadphonesonphysiologicalresponsesforchildrenwith autismspectrumdisorder.egin{array}[t]{l} { extrm {Frontiers Integrative Neuroscience, }
ightarrow t(, ext{13)}}$oxed{$^lacksquare_lacktriangledown${{fnint 2019.}{0}{{5}}}
olimits& Ramezani M Lotfi Y MoossaviA &BakhshiE (2021) extit {(Effects auditory processing training speech perception brainstem plastisity adolescentsautismspectrum disorders)} Iranian Journal Child Neurology$^{},,${}$-{ extstyle{6}-{8}}} . ag{}
onumber&&https://doi.org/{ijcn.v15i2 }.4}\Reynolds S Miller Kuhaneck H extbf {.Pfieffer}(2016). extit{(Systematic Review Effectiveness Frequency Modulation Devices Improving Academic Outcomes Children With Auditory Processing Difficulties)}.The American journalof occupational $ imes$(,),-$- rac{-}{+}-{7}. $$ https://doi.org/ times{} ${ndis}.24//AJA - $.[ex]MealingsK.(2022). A review of Classroom Sound Field Amplification OnChildren In Primary School.egin{array}[t]{l} { extrm {AmericanjournalOf audiology, }
ightarrow t(, ext{31)}}$oxed{$^lacksquare_lacktriangledown${{aja 21.}{0}{{4}}}
olimits& MednicoffS.D Barashy.S GonzalesD BenningSD SnyderJS &HannonEE (2022) extit {(Auditory affective processing musicality and the development misophonic reactions)} Frontiers in Neuroscience$^{},,${}$-{ extstyle{9}-{8}}} . ag{}
onumber&&https://doi.org/{fnins }.{2022.}{9}oxplus_lacksquare}\Moossavi,A MoallemiM
onumber&(2019). extbf{(Approaches auditoryprocessingandaudiatoryrehabilitationautism)}.$$
ight)$,$ imes$(,),-$- rac{-}{+}-{6}& https://doi.org/ times{} ${avr.v28i1}. ${4}$.[ex]MurphyC.F.B SchochatE.(2013).Effects different types ofauditory temporal training language skills systematic review.egin{array}[t]{l} { extrm {Clinics Sao Paulo Brazil, }
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olimits& Neave-DiToro D FuseA Bergen.M.,(2021)Knowledge awareness ear protection devices sound sensitivity individuals autism spectrum disorders Language Speech Hearing Services Schools $52 $( ext{)},~^{4}${7}. $ ag{},LanguageSpeechHearingServicesinSchools/{52( ext{)}},$-{ extstyle{4}-{2}}} .
onumber&&https://doi.org/{LSHSS - 9 } $. \NolanD.R GuptaR HuberCG &SchneebergerAR (2020). extbf{(An effective treatment tinnitus hyperacusis based cognitive behavioral therapy inpatient setting retrospective outcome analysis)}.Frontiers Psychiatry,$^{} imes$(,),-$- rac{-}{+}-{2}& https://doi.org/ times{} ${fpsyt }.}{20.}$.[ex]OcakE EshraghiRS DaneshAMittalREshraghiaaAA
onumber&(2018) extit {(Central auditory processing disorder individualswithautism spectrumdisorders).Balkan Medical Journal}$,,${}^oxed{$lacktriangledown${{balkanmedj 18}}}
olimits& Pfeiffer B Erbsr SluggL(2019). extit {Impact of noise attenuating headphones on participation home community school children with autism spectrum disorders Physical Occupational Therapy Pediatrics $39 $( ext{)},
ight)$, times{}$${ extstyle{ extit{Approaches}}$ imes$audiatoryprocessingandrehabilitationautism. } $$ ag{}
onumber && https://doi.org/10.{ extstyle{{avr.v28i1.410}}}[7em] extbf{Murphy,C.F.B., extrm{Schochat, E}(2013). Effects of different types auditory temporal training on language skills a systematic review } ag{}
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onumber & $https://doi.org/{clinics}/2013($10))_{12}\[5ex]Neave-DiToro,D,FuseA.& Bergen.M.(2021). extit{Knowledge and awareness ear protection devices for sound sensitivity individuals with autism spectrum disorders}. Language Speech Hearing Services in Schools,$^{},{$52 $( ext{)}$.1},~^{4}$$^oxed{9}{-oxplus_lacksquare}-$. ag{}&&$https://doi.org/ times{}${LSHSS- 19 - 00119 }\ extbf{
olimitsNolan.D.R,Gupta,R.Huber.C.G,& Schneeberger.AR(2020)}.An effective treatment tinnitus hyperacusis based cognitive behavioral therapy an inpatient setting A egin{array}[t]{l} { extrm{retrospective outcome analysis}}[-.5em] extit{Frontiers Psychiatry, } imes t(, ext{11), ~$oxed{25.$ }} & https://doi.org/10.{fpsyt}.2020._00025}
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onumber & Ocak,E., Eshraghi R.S Danesh,A,Mittal,R.Eshraghia.a.A (2018).Central auditory processing disorder individualswithautismspectrumdisorders.Balkan Medical Journal$,3$(5)$,-{67}-{-}{7}$ . $ ag{}
onumber && $https://doi.org/{balkanmedj}.2018$lacktriangle_4$.}[+ex]Pfeiffer,B.,Erb,S.R.& Slugg,L.(2019a). extit{Impact of noise attenuating headphones on participation home community school children with autism spectrum }\ extit{ times{}$${Physical Occupational Therapy Pediatrics}, 39( ext{(}) ,~^,$^ rac{{-}{6}}{{7}-$. ag{$)}&&https://doi.org/ extcolor[rgb]{0,.5,…:Occupational} egin{array}[t]{l} { extrm {Therapy inPediatrics}}[-.5em] extit{Physiological responses forchildrenwith autismspectrum disorders } ag{},Frontiers Integrative Neuroscience, (, imes t)$$^{13), $oxed{6}oxplus_lacksquare_$.$ }}& https://doi.org/10.{fnint}.2019._00065
onumber & Ramezani,M.Lotfi,Y.Moossavi,A,& Bakhshi,E (2021).Effects auditory processing training speech perception brainstem plastisity adolescentsautism $
onumber && $spectrumdisorders.Iranian Journal Child Neurology$,{ iny{15$( ext{)}}$.}$- rac{-}{+}- rac{8}{4}$ . $ ag{}
onumber && $$https://doi.org/{ijcn.v15i2_22037}\Reynolds,S.,Miller Kuhaneck,H.& Pfeiffer,B.(2016). times{}$${Systematic Review Effectiveness Frequency Modulation Devices Improving Academic Outcomes Children With Auditory Processing Difficulties.egin{array}[t]{l} { extrm {American journal of occupational}}[-.5em] extit{ times{}$${Auditory differences autism } ag{},Page 12of oxed{{}{14}}}&& Page^{21}{$$ imes$$^,$^oxplus_lacksquare${23}
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onumber&&https://doi.org/{occupational }.4}\Pfeiffer,B Stein Duker L Murphy A Shui C (2019). extbf{(Effectivenessofnoiseattenuatingheadphones physiological responses forchildrenwith autismspectrumdisorder)}.Frontiers Integrative Neuroscience,$^{}
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olimits& ReynoldsS MillerKuhaneckH Pfeiffer B.egin{array}[t]{l} { extrm {Systematic Review Effectiveness Frequency Modulation Devices Improving Academic Outcomes Children With Auditory Processing Difficulties}.The American journal of occupational $ imes$(,),-$oxplus$-{ extstyle{7}}} . ag{},AmericanjournalOfOccupationalAuditorydifferencesin autism }
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olimits&MurphyC.F.B.Schochat,E(2013). Effects ofdifferenttypesofauditorytemporaltraining onlanguage skil ls a systemati creview. Clini cs(Sa oPaulo,Braz il), {$}^- {-}{+}- rac {5-{}}{{7}-{}}$. $$https://doi.org/{cl inic s}/2013({(}) _ {10))} {.}[ex]Neave-DiToro,D FuseA Bergen M.(2021)Knowledge awareness ear protection devices sound sensitivity individuals autism spectrum disorders Language Speech Hearing Services Schools $^{}
ightarrow$$~ $.\boxed{redacted: s47F - Personal privacy}& NolanD R GuptaR HuberCG,&SchneebergerAR
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ight)$,lacksquare- {-}{9}. $$https//doi.org/{fnins }. _ {2022} {.}[ex]Mo oss aviA.MoallemiM (2019).Approachesauditoryproces singandaudiatoryrehabilitationautism.$$${10), }$$^- {-7. } ag{},Clinicss/2013($
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OFFICIAL
For Internal Use Only
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Yuan, H.-L., Lai, C.Y.Y., Wong, M.N.K., Kwong, T.C., Choy, Y.S., Mung, S.W.Y., Chan, C.C.H. (2022). Interventions for sensory over-responsivity in individuals with autism spectrum disorder: A narrative review.Children (Basel, iSwitzerland), in(i)1584. https://doi.org/10.3390/children9101584 Zai,G., Dembo,J., Levitsky,N.& Richter,M.A.(2022).Misophonia:A detailed case series and literature review.The Primary Care Companion to CNS Disorders, 24({)}.https://doi.org/<a href=