Could a Simple Hearing Test Diagnose Autism?

Big Ear

A recent study published in Autism Research is stirring controversy over reports that a simple hearing test may help with early autism diagnosis. The test is the auditory stapedial reflex (ASR) test which measures how one of the two middle ear muscles called the stapedius contracts in response to loud sounds.  According to the authors of the study an absent reflex would indicate an autism risk factor.

The reflex attenuates sudden loud sound to protect the delicate inner hair cells from damage. Without this sound dampening the auditory system is bombarded by sound which results in a number of behavioral responses such as covering of ears, running from the sound, aggression, and more.  These are characteristically fight/flight behaviors seemingly in response to sound, in this case a stressor. Last year I published an article with Dr. Jay Lucker in Autism Science Digest identifying that in most cases the response is an emotional rather than auditory response that can be trained with music listening therapy and behavioral techniques and is not exclusive to people diagnosed with autism.

If you read the research abstract (link below) you’ll see the investigators are making an argument for absent reflexes as an autism biomarker. My concern is they tested children with autism compared to a smaller group which was “neurotypical” but not other neurodevelopmental disorders which based on my experience would very likely yield the same results… Auditory deficits are a common feature in autism chief among them hypersensitivity to sound in which the brain appears unable to filter out undesirable sound resulting in pain or discomfort.  However this is also true of Sensory Processing Disorder, ADHD, Auditory Processing Disorder, etc.

I’m pleased to see the attention on the auditory system in the autism research field, but caution looking to the ASR as a reliable autism biomarker without further study. What are your thoughts?

Abstract:  Quantification of the Stapedial Reflex Reveals Delayed Responses in Autism Autism Res 2013

4 thoughts on “Could a Simple Hearing Test Diagnose Autism?

  1. Mom of kid with APD says:

    Interesting. My son had an absent reflex then did a listening therapy and the reflex returned and has remained normal ever since. He also had significant sound sensitivity which significantly improved with the listening therapy.

    I was told an absent reflex can occur due to excessive ear infections, which my son had (11 in 22 months, 5 of them double ear infections). My son was assessed repeatedly for autism but always came back negative. He did have auditory processing disorder though. There are other parents on our APD board who have reported absent reflexes too, but their kids were not diagnosed with autism.

    I’m not very convinced by this study…

  2. Jessica Lough says:

    I agree with your concerns – this is a sloppy extrapolation. The presence of an immature moro reflex affects the stapedal reflex but that does not mean that all individuals with an immature moro reflex fall within an ASD diagnosis….An early ASR test may however be useful in identifying infants and children who are generally more prone to stress.

  3. Dorothy says:

    There are studies suggesting that auditory filter shapes cause difficulties with speech and language, particularly speech-in-noise. However, this is not the test used in these studies.

  4. Barbara Kelly says:

    Great post! I like the suggestions. Autism is number one birth defect found in children. It is really very important to diagnose autism at earlier stages as it can cause several issues later. There are most children which are diagnosed before they reach the age of four while many of them are diagnosed as early as age one. Hearing test can be a great source to find out whether the child has autism or not. If a child has autism, then he will not respond properly to sounds. Most of the hearing health specialists suggest for hearing test to diagnose autism.

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