J Am Acad Audiol 2019; 30(05): 431-443
DOI: 10.3766/jaaa.18062
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of Auditory Training and Remote Microphone Technology on the Behavioral Performance of Children and Young Adults Who Have Autism Spectrum Disorder

Erin C. Schafer
*   University of North Texas, Denton, TX
Kamakshi V. Gopal
*   University of North Texas, Denton, TX
Lauren Mathews
*   University of North Texas, Denton, TX
Skyler Thompson
*   University of North Texas, Denton, TX
Kara Kaiser
*   University of North Texas, Denton, TX
Sarah McCullough
*   University of North Texas, Denton, TX
Jessalyn Jones
†   Rady Children’s Hospital, San Diego, CA
Priscilla Castillo
*   University of North Texas, Denton, TX
Emilee Canale
*   University of North Texas, Denton, TX
Avery Hutcheson
*   University of North Texas, Denton, TX
› Author Affiliations
Further Information

Publication History

12 November 2018

30 November 2018

Publication Date:
26 May 2020 (online)



Individuals who have a normal pure-tone audiogram but are diagnosed with autism spectrum disorder (ASD) often exhibit poorer speech recognition and auditory processing when compared with neurotypical peers with normal pure-tone audiograms.


The purpose of this study was to determine the efficacy and effectiveness of a 12-week auditory processing training (APT) program that was designed to address the deleterious effects of background noise and auditory processing deficits that are common among individuals diagnosed with ASD.

Research Design:

A repeated measures design was used.

Study Sample:

The sample consisted of 15 high-functioning children and young adults who had a formal diagnosis of ASD and who were recruited from local clinics and school districts.


Participants completed the 12-week APT program consisting of computerized dichotic training, one-on-one therapist-directed auditory training, and the use of remote microphone (RM) technology at home and in the classroom.

Data Collection and Analysis:

Participants completed a comprehensive test battery to assess general auditory processing skills, speech recognition in noise, acceptance of background noise, spatial processing, binaural integration abilities, self-perceived difficulties, and observed behaviors. Testing was conducted before (n = 15), immediately after (n = 15), and 12 weeks after (n = 7) the completion of the APT program. Paired t-tests, repeated measures analysis of variance, or nonparametric tests were used to analyze the data.


On average, the APT program significantly enhanced general auditory processing abilities, including binaural integration and subjective listening abilities in the classroom. When the RM was used, significantly improved speech recognition and improved acceptance of background noise was measured relative to a condition with no technology.


Following the APT program, the participants exhibited the greatest improvements in testing that required binaural integration and auditory working memory. The use of the RM technology was able to address the deleterious effects of noise on speech recognition in noise and acceptance of noise levels.

This study was funded by a research grant from the Texas Higher Education Coordinating Board.

Portions of this manuscript have been presented at the American Academy of Audiology conferences in 2017 and 2018, the American Speech-Language-Hearing Association in 2017, and the Educational Audiology Conference in 2017.


  • Alcántara JI, Weisblatt EJ, Moore BC, Bolton PF. 2004; Speech-in-noise perception in high-functioning individuals with autism or Asperger’s syndrome. J Child Psychol Psychiatry 45 (06) 1107-1114
  • American Psychiatric Association 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association;
  • Anderson K, Smaldino J, Spangler C. 2011 Listening Inventory for Education–Revised (L.I.F.E.-R.). https://successforkidswithhearingloss.com/ . Accessed January 1, 2015
  • ANL 2009. Acceptable noise level: ANL Kelowna: Cosmos Distributing Co. Ltd;
  • Ashburner J, Rodger S, Ziviani J. 2008; Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. Am J Occup Ther 62: 564-573
  • BKB-SIN 2005. BKB-SIN: Bamford-Kowal-Bench Speech in Noise Test. Elk Grove Village, IL: Etymotic Research;
  • Cameron S, Dillon H. 2007. Listening in Spatialized Noise - Sentence Test (Version 2.400) [Computer Software] Sydney, Australia: National Acoustic Laboratories;
  • CAPDOTS-Integrated 2018 [Computer Software]. capdots.com
  • Cruckley J, Scollie S, Parsa V. 2011; An exploration of non-quiet listening at school. J Educ Audiol 17: 23-35
  • Denman I, Banajee M, Hurley A. 2015; Dichotic listening training in children with autism spectrum disorder: a single subject design. Int J Audiol 54 (12) 991-996
  • Dichotics, Inc. (n.d.) Audia Dichotic (Version 1.4.4) [Computer Software]. dichoticsinc.com/#software
  • Dunn W. 2014. Sensory Profile 2 Manual. San Antonio, TX: Pearson;
  • Friederichs E, Friederichs P. 2005; Electrophysiologic and psycho-acoustic findings following one-year application of a personal ear-level FM device in children with attention deficit and suspected central auditory processing disorder. J Educ Audiol 12: 31-36
  • Hammill DD, Pearson NA, Weiderholt JL. 2009. Comprehensive Test of Nonverbal Intelligence. 2nd ed. Austin, TX: PRO-ED;
  • Hayashi M, Takamura I, Kohara H, Yamazaki K. 1989; A neurolinguistic study of autistic children employing dichotic listening. Tokai J Exp Clin Med 14 (04) 339-345
  • Hornickel J, Zeker SG, Bradlow AR, Kraus N. 2012; Assistive listening devices drive neuroplasticity in children with dyslexia. Proc Natl Acad Sci USA 109 (41) 16731-16736
  • Hugdahl K, Westerhausen R, Alho K, Medvedev S, Laine M, Hämäläinen H. 2009; Attention and cognitive control: unfolding the dichotic listening story. Scand J Psychol 50 (01) 11-22
  • Johnston K, John A, Kreisman N, Hall J, Crandell C. 2009; Multiple benefits of personal FM system use by children with auditory processing disorder (APD). Int J Audiol 48 (06) 371-383
  • Kozou H, Azouz HG, Abdou RM, Shaltout A. 2018; Evaluation and remediation of central auditory processing disorders in children with autism spectrum disorders. Int J Pediatr Otorhinolaryngol 104: 36-42
  • Knecht H, Nelson P, Whitelaw G, Feth L. 2002; Background noise levels and reverberation times in unoccupied classrooms: predictions and measurements. Am J Audiol 11 (02) 65-71
  • Loo JH, Rosen S, Bamiou DE. 2016; Auditory training effects on the listening skills of children with auditory processing disorder. Ear Hear 37 (01) 38-47
  • Macizo P, Soriano MF, Paredes N. 2016; Phonological and visuospatial working memory in autism spectrum disorders. J Autism Dev Disord 46 (09) 2956-2967
  • Martin NA, Brownell R. 2005. Test of Auditory Processing Skills. 3rd ed. Novato, CA: Academy Therapy Publications;
  • Moncreiff D. 2015; Age- and gender-specific normative information from children assessed with a dichotic words test. J Am Acad Audiol 26: 632-644
  • Moncreiff DW, Wilson RH. 2009; Recognition of randomly presented one-, two-, and three-pair dichotic digits by children and young adults. J Am Acad Audiol 20: 58-70
  • Moncrieff D, Keith W, Abramson M, Swann A. 2017; Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia. Int J Audiol 56 (08) 580-588
  • Rance G, Chisari D, Saunders K, Rault JL. 2017; Reducing listening-related stress in school-aged children with autism spectrum disorder. J Autism Dev Disord 47 (07) 2010-2022
  • Rance G, Saunders K, Carew P, Johansson M, Tan J. 2014; The use of listening devices to ameliorate auditory deficit in children with autism. J Pediatr 164 (02) 352-357
  • Schafer EC, Bryant D, Sanders K, Baldus N, Algier K, Lewis A, Traber J, Layden P, Amin A. 2014; a Fitting and verification of frequency modulation systems on children with normal hearing. J Am Acad Audiol 25 (06) 529-540
  • Schafer EC, Mathews L, Mehta S, Hill M, Munoz A, Bishop R, Moloney M. 2013; Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): an initial investigation. J Commun Disord 46 (01) 30-52
  • Schafer EC, Traber J, Layden P, Amin A, Sanders K, Bryant D, Baldus N. 2014; b Use of wireless technology for children with auditory processing disorders, attention-deficit hyperactivity disorder, and language disorders. Sem Hear 35 (03) 193-205
  • Schafer EC, Wright S, Anderson C, Jones J, Pitts K, Bryant D, Watson M, Box J, Neve M, Mathews L, Reed MP. 2016; Assistive technology evaluations: remote-microphone technology for children with autism spectrum disorder. J Commun Disord 64: 1-17
  • Scollie S, Seewald R, Cornelisse L, Moodie S, Bagatto M, Laurnagaray D, Beaulac S, Pumford J. 2005; The desired sensation level multistage input/output algorithm. Trends Amplif 9 (04) 159-197
  • Smart JL, Purdy SC, Kelly AS. 2017; Impact of personal frequency modulation systems on behavioral and cortical auditory evoked potential measures of auditory processing and classroom listening in school-aged children with auditory processing disorder. J Am Acad Audiol 29 (07) 568-586
  • Smoski WJ, Brunt MA, Tannahill JC. 1998. Children’s Auditory Performance Scale. Tampa, FL: Educational Audiology Association;
  • Tomchek SD, Dunn W. 2007; Sensory processing in children with and without autism: a comparative study using the short sensory profile. Am J Occup Ther 61 (02) 190-200
  • Vogan V, Francis K, Morgan B, Smith ML, Taylor M. 2018; Load matters: neural correlates of verbal working memory in children with autism spectrum disorder. J Neurodev Disord 10: 19
  • Wang Y, Zhang YB, Liu LL, Cui JF, Wang J, Shum DH, van Amelsvoort T, Chan RC. 2017; A meta-analysis of working memory impairments in autism spectrum disorders. Neuropsychol Rev 27 (01) 46-61
  • Weckstein SM, Weckstein EJ, Parker CD, Westerman MW. 2017; A retrospective chart analysis with follow-up of Cogmed Working Memory Training in children and adolescents with autism spectrum disorder. Med Sci Monit Basic Res 16 (23) 336-343
  • Weihing J, Musiek F. 2014. Dichotic interaural intensity difference (DIID) training. In: Chermak G, Musiek FE. Handbook of Central Auditory Processing Disorders. 2nd ed. San Diego, CA: Plural Publishing; 225-242
  • Wiig EH, Semel E, Secord WA. 2013. Clinical Evaluation of Language Fundamentals. 5th ed. Bloomington, IN: NCS Pearson;