自闭症谱系障碍儿童的听觉诱发电位研究进展

自闭症谱系障碍儿童通常表现出对声音刺激的异常反应,前期针对其听觉功能的研究多采用客观听觉电生理测试,主要包含听性脑干反应及一系列皮层听觉诱发电位。综合这些研究中的结果提示,与正常发育儿童相比,自闭症谱系障碍儿童存在一定程度的中枢听觉信息处理障碍。本文对此进行综述。     

自动前注意听觉应答：学龄期自闭症儿童短纯音频率变化的失匹配负波

自闭症由Kanner最早发现命名,是一种广泛性发育障碍,包括社交障碍、沟通障碍和适应能力不足。自闭症的病因并不完全明确,但是大脑机制以及遗传因素可能是重要因素。对环境声音变化的前注意加工是人类感知和认知的最基本的组成部分,前注意加工不足导致了自闭症儿童的一系列临床表现,如听觉及言语功能异常。失匹配负波（mismatch negativity,MMN）是一种由刺激变化诱发的事件相关电位（event－related potentials,ERP）,MMN 的诱发不需要患者的主动注意,是反映听觉信息前注意加工的可靠指标。本课题研究学龄期自闭症儿童的听觉MMN事件相关电位是否发生变化,并将其与一组年龄相当的正常儿童的听觉MMN事件相关电位进行比较。     

学龄前期自闭症谱系障碍儿童与健听儿童言语诱发听性脑干反应的比较研究

目的　比较学龄前期自闭症谱系障碍（autism spectrum disorders,ASD）患儿与健听儿童言语诱发听性脑干反应（speech evoked auditory brainstem responses,speech-ABR）的基本特征,探讨ASD患儿脑干言语处理能力。方法　对声导抗、耳声发射、短声听性脑干反应测试结果正常的10例ASD患儿（3～6岁）和9名健听儿童（3～6岁）行speech-ABR测试,采用强度为80 dB SPL的/da/作为刺激声。结果　两组speech-ABR曲线均由瞬态成分（V、A、C、O）和周期性成分（D、E、F）组成,两组潜伏期及波幅差异均 无统计学意义（P＞0.05）。结论　学龄前ASD患儿与健听儿童speech-ABR具有相似的基本特征,两者脑干言语处理能力相近。     

持续进行性口吃患者的言语声诱发听性脑干反应

持续进行性口吃(persistent developmental stuttering,PDS)是一种儿童时期发病至成人仍不恢复的言语流畅障碍性疾病,发病机制至今尚未明确.一些电生理学研究表明口吃患者存在着听觉皮层的功能障碍,其听觉信息处理缺陷被认为是其基础机制.最近神经学研究发现,PDS患者皮层下中枢的听觉和运动区(例如基底神经节)出现异常神经活动.有学者指出,听觉脑干可能是PDS患者听觉中枢功能的缺陷部位.     

特殊需要儿童认知干预的理论与实践(Ⅱ)

1 前言 认知能力是个体智力的核心,也是个体思维,学习和适应环境的基础.智力发育迟缓、听觉障碍、语言障碍、脑性瘫痪和自闭症等儿童往往存在不同程度的认知问题,需要接受认知干预.     

中枢听觉认知的不对称性研究及双耳分听的应用进展

人类区别于动物的一个重要特征是语言功能。语言是一种具有特殊意义的声音。人类听觉系统的大部分功能都用在对言语声的辨听上,但是,言语声这种复杂信号是如何处理并最终反映在认知上的,目前尚不十分明了。较为明确的是,与大脑功能一样,中枢听觉也存在双侧不对称性［1,2］,双耳听觉较单耳听觉在听觉信息处理方面具有一定优势［3,4］,即便是在电刺激诱发的听觉反应中,同样存在双耳优势［5～15］;这一优势的显现取决于听觉系统能否对双耳接收到的听觉信息分别作出识别反应并成功整合,这一过程涉及到一系列信息传导、解码、重建以及更为复杂的高级认知功能。一直以来,听力学家、神经学家以及心理学家都在探索听觉信息的中枢处理机制,并利用了各种研究手段和技术,双耳分听（dichotic listening）是其中应用较广的研究中枢听觉认知行为的一种方法。本文就目前关于中枢听觉认知的研究及双耳分听在其中的应用进行综述。     

中枢听觉处理障碍

中枢听觉处理障碍(central auditory processing disorders,CAPD)是指中枢听觉神经系统的功能受损而致的听功能缺陷,本文首先综述了CAPD的临床症状、特点及可能之病因.之后阐述了听觉内外余力对听觉言语测试的影响以及降低外余力的方法;听力损失、认知能力、药物、测试程式对CAPD测试的影响;言语测试和非言语测试的优缺点;不同测试模式的影响.最后阐述了CAPD的一些具体测试方法以及对测试结果进行测试时要注意的因素.     

中枢听觉处理障碍

中枢听觉处理障碍（central auditory processing disorders,CAPD）是指中枢听觉神经系统的功能受损而致的听功能缺陷,本文首先综述了CAPD的临床症状、特点及可能之病因.之后阐述了听觉内外余力对听觉言语测试的影响以及降低外余力的方法;听力损失、认知能力、药物、测试程式对CAPD测试的影响;言语测试和非言语测试的优缺点;不同测试模式的影响.最后阐述了CAPD的一些具体测试方法以及对测试结果进行测试时要注意的因素.     

失匹配负波与听觉辨别

听觉辨别(auditory discrimination)是对声音物理特性或属性的各参数最小差值的分辨能力,美国言语语言听力协会将其列为中枢听觉处理功能之一[1],其反映的是大脑对听觉刺激阈上差异分辨的能力,反映听觉系统识别声学特征的精确度,即听觉系统对声音的传导以及神经的编码精度.既往人们主要通过行为学测试来主观评估听觉辨别等中枢听觉功能,而随着电生理技术的发展,尤其是近年来失匹配负波(mismatch negativity, MMN)的研究不断深入,客观了解中枢听觉处理机制正逐渐成为可能.现对MMN与听觉辨别的关系综述如下.     

老年性聋患者中枢听觉处理障碍的认识现状和研究手段

概述 随着经济的不断发展与人民健康保健水平的提高,我国正逐步进入人口老龄化社会.根据相关统计,我国目前老年人口为1.3亿,占总人口比重的11%;而预计2040年左右,老年人口将增长到4亿多.老年性聋是世界第三大常见慢性疾病.2006年进行的全国第二次残疾人抽样调查中,对39166名60岁以上老年人进行了听力抽样,根据该调查结果数据推算,全国总共有60岁以上单纯性听力残疾者1540.47万,其中老年性聋1364.49万[1].美国听觉、生物声学和生物力学委员会的定义较为准确地概括了老年听力损失的发病原因和相关因素之间的作用:"老年性听力损失是由多种生理机能恶化总和引起的,除了生理衰老外,还包括噪声接触,服用耳毒性药物、过量用药和其他各种疾病等"[2].听觉中枢处理障碍在老年性聋中所占的比重很大,且中枢处理能力的衰退速度快于外周听觉功能.这使得言语识别障碍特别是噪声环境下的言语识别障碍成为老年性聋最主要的功能性障碍.本文就老年性聋患者中枢听觉处理障碍的研究现状和研究手段进行简要综述.     

Dichotic listening training in children with autism spectrum disorder: A single subject design

Objective: Previous research has shown that dichotic listening training has improved auditory and language processing for individuals with large interaural asymmetries on dichotic listening tasks. This training can be a useful treatment for children with autism spectrum disorder (ASD). Design: A single subject, multiple baseline across subjects study was utilized. Study sample: Three children with ASD, between the ages of 8–12, participated in the study. Results: This training demonstrated improvement in language and auditory processing tasks following completion of up to twelve weeks of auditory training. Conclusion: This study supports the idea that deficit specific, dichotic auditory training can remediate auditory and language deficits for children with ASD. More research is needed, with a group design and controls, in order to generalize these results to the larger ASD population.     

Motor–auditory–visual integration: The role of the human mirror neuron system in communication and communication disorders

The mirror neuron system (MNS) is a trimodal system composed of neuronal populations that respond to motor, visual, and auditory stimulation, such as when an action is performed, observed, heard or read about. In humans, the MNS has been identified using neuroimaging techniques (such as fMRI and mu suppression in the EEG). It reflects an integration of motor–auditory–visual information processing related to aspects of language learning including action understanding and recognition. Such integration may also form the basis for language-related constructs such as theory of mind. In this article, we review the MNS system as it relates to the cognitive development of language in typically developing children and in children at-risk for communication disorders, such as children with autism spectrum disorder (ASD) or hearing impairment. Studying MNS development in these children may help illuminate an important role of the MNS in children with communication disorders. Studies with deaf children are especially important because they offer potential insights into how the MNS is reorganized when one modality, such as audition, is deprived during early cognitive development, and this may have long-term consequences on language maturation and theory of mind abilities.Learning outcomes: Readers will be able to (1) understand the concept of mirror neurons, (2) identify cortical areas associated with the MNS in animal and human studies, (3) discuss the use of mu suppression in the EEG for measuring the MNS in humans, and (4) discuss MNS dysfunction in children with (ASD).     

Autism and peripheral hearing loss: A systematic review

Objective

To systematically review the literature describing the relationship between autism spectrum disorder (ASD) and peripheral hearing loss including literature recommendations for audiological assessment and auditory habilitation in cases where peripheral hearing loss and ASD coexist.

Data sources

Published studies indexed in MEDLINE (1948–2011).

Review methods

The search strategy identified 595 potential studies. After a review of the titles, 115 abstracts were reviewed and 39 articles were retrieved and assessed independently by at least two authors for possible inclusion. 22 articles pertained to children with ASD and peripheral hearing loss, hearing assessment in children with ASD, audiological habilitation for children with ASD or hyper-responsiveness in children with ASD. 17 further studies were garnered from the reference section of the 22 papers.

Results

Controversy exists in the literature regarding prevalence of hearing impairment among individuals with ASD. In cases where ASD and hearing impairment co-exist, diagnosis of one condition often leads to a delay in diagnosing the other. Audiological assessment can be difficult in children with ASD and test–retest reliability of behavioural thresholds can be poor. In cases where hearing impairment exists and hearing aids or cochlear implantation are recommended, devices are often fit with special considerations for the child with ASD. Hyper-responsiveness to auditory stimuli may be displayed by individuals with ASD. Evidence or the suspicion of hyper-responsiveness may be taken into consideration when fitting amplification and planning behavioural intervention.

Conclusions

Prevalence rates of hearing impairment among individuals with ASD continue to be debated. At present there is no conclusive evidence that children with ASD are at increased risk of peripheral hearing loss. A complete audiological assessment is recommended in all cases where ASD is suspected so as not to delay the diagnosis of hearing impairment in the event that hearing loss and ASD co-exist. Objective assessment measures should be used to confirm behavioural testing in order to ensure reliability of audiological test results. Fitting of hearing aids or cochlear implantation are not contraindicated when hearing loss is present in children with ASD; however, success with these devices can be variable.     

孤独症儿童脑干听觉诱发电位及耳声发射研究

目的探讨孤独症对听觉系统功能的影响,为临床诊治提供理论依据。方法对20例孤独症患儿进行听觉脑干诱发电位（auditory brainstem response,ABR）及畸变产物耳声发射（distortion Product otoacoustic emission,DPOAE）测试,设立同年龄段正常组进行对照研究。结果①孤独症组ABR双耳Ⅴ波潜伏期、右耳Ⅰ～Ⅴ波间期、Ⅲ～Ⅴ波间期延长,与对照组比较有显著性差异（P〈0．05）;②孤独症组DPOAE异常率增高,1kHz及1．5kHz平均幅值及1kHz引出率降低,与对照组比较有显著性差异（P〈0．05）。结论孤独症儿童ABR潜伏期延长,DPOAE测试异常率增高,提示脑干听觉通路传导异常,可能是引起孤独症儿童广泛感觉系统发育障碍,使言语、认知、社会等方面异常发育的原因之一。     

The correlation between central auditory processing in autistic children and their language processing abilities

AimTo study the auditory profile at different levels of the auditory system in children with ASD and to verify the role of (Central) auditory processing disorder as an essential pathology of the autistic disorder or as an associated co-morbidity, and to establish the correlation between CAP findings and the language delay in these cases.PatientsThe study included 30 children with definite autistic disorder according to DSM-IV-TR criteria and ADI-R among those attending the outpatient neuropsychiatry clinic of Alexandria University Children Hospital at El Shatby. An informed consent was taken from all patients in this part of the study. Confidentiality of the records was maintained.MethodsAll cases were subjected to complete history taking and examination; special assessment to language skills and evoked potentials were done.ResultsThe results concluded that (central) auditory processing disorder is an essential pathology of the autistic disorder. Autistic children possess a dysfunctioning or an immature central auditory nervous system at both the brainstem and cortical levels.     

Auditory symptoms and autistic spectrum disorder: A scoping review and recommendations for future research

IntroductionAuditory symptoms in individuals with Autistic Spectrum Disorder (ASD) are well described within the neurodevelopmental literature, yet there is minimal mention of ASD in Otolaryngology literature. This is surprising considering the potential clinical and diagnostic implications of this link, and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms. The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology, and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology.MethodsWe searched Pubmed, Embase, Ovid and Cochrane library for studies until November 2021. Four authors independently reviewed 227 publications identified. 39 were filtered into the final analysis. The PRISMA 2020 guidelines were followed. The heterogeneity of literature meant that a Systematic Review was not feasible. Included studies were therefore classified thematically, forming the basis of the scoping review.ResultsDiagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain. There is a growing body of literature on auditory symptoms in ASD, suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms, and indicating a learning need for Otolaryngologists and audiologists, to whom these patients may present.ConclusionWe recommend a research agenda focusing on multidisciplinary collaboration, stakeholder engagement, responsible clinical screening, and clarification of pathophysiological mechanisms and terminology.     

"Listen my children and you shall hear": auditory preferences in toddlers with autism spectrum disorders.

PURPOSE: This study tests the hypothesis that toddlers with autism spectrum disorders (ASD) will show differences from contrast groups in preferences for attending to speech. METHOD: This study examined auditory preferences in toddlers with ASD and matched groups of (a) typical age-mates, (b) age-mates with nonautistic developmental disabilities, and (c) younger children matched for language age. The experimental procedure measured time spent oriented to auditory stimuli that were created to exemplify language patterns that had been studied in typically developing infants. RESULTS: Findings suggest that toddlers with ASD show a reduced preference for child-directed speech, compared with typical age-mates, but few differences from children with nonautistic developmental disorders. Correlational analysis revealed that time spent listening to child-directed speech by children with ASD was related to their concurrent receptive language ability as well as to receptive language abilities 1 year later. This relationship did not hold for the other groups. CONCLUSION: The present study supports the hypothesis that children with ASD perform differently from typical peers in auditory preference paradigms and that performance in these tasks is related to concurrent and later language development.     

Auditory brainstem response in two children with autism

Autism develops before 30 months of age. Autistic disorder is characterized by a qualitative impairment in verbal and non verbal communication, in imaginative activity, and in reciprocal social interactions. Communication in autism is so strikingly impaired that the function of the hearing system has been under study over the past 30 years, namely after the advent of physiological assessment of hearing with the auditory brainstem response (ABR). Many research studies were developed to study ABR in autism as they constitute a direct test of both hearing status and integrity of brainstem pathways, but the results obtained are contradictory. The authors present case reports of two children with autistic disorder, 2 and 4 years of age, in which the ABR findings document a prevalent Peak I in the four ears tested. This characteristic configuration in ABR has not been previously reported and future work is needed to establish the importance of this finding and its implications in the awareness of the auditory status in these children.     

儿童中枢听处理障碍的发展历史

中枢听处理障碍是听觉系统特有的一种障碍类型,表现为中枢听神经对听觉信号的感知处理存在困难,在听觉定位、偏侧化、模式识别、时间处理、竞争信号下的听觉处理及衰减信号下的听觉处理技能有所缺失。本文总结了儿童听处理障碍的发展历史,将其归纳为萌芽期、探索期及发展期,以使读者深刻理解听处理障碍,并为听处理障碍儿童的康复提供指导。