Brainstem auditory evoked potentials in children with autism spectrum disorder

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ASD, autism spectrum disorders; TD, typical development; ms, milliseconds; μV, microvolts." ] ] ] "textoCompleto" => "IntroductionAutism spectrum disorder (ASD) is a central disorder characterized by the inability to establish interpersonal relationships and to react normally to situations early in life, with an emphasis on social withdrawal.<a class="elsevierStyleCrossRef" href="#bib0155">1</a>According to the Diagnostic and Statistical Manual of Mental Disorders,<a class="elsevierStyleCrossRef" href="#bib0160">2</a> individuals with ASD may exhibit behavioral patterns that include restricted interests and repetitive and stereotyped behaviors. Furthermore, changes in reciprocal social interactions and modes of communication are observed. Additionally, it is known that individuals with ASD may have perceptual, cognitive, and memory disorders of attention that can be mistaken for auditory deficiencies.<a class="elsevierStyleCrossRef" href="#bib0160">2</a>Moreover, individuals with ASD may be hyper- or hyposensitive to sensory stimuli and can be very sensitive to sounds; they may be troubled by loud sounds (hyperacusis) or be unable to hear and respond to loud sounds or noises (hypoacusis). Such sensitivities are also observed in relation to light and tactile sensation.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> Consequently, it is important to perform a complete audiological assessment that investigates both the peripheral and the central auditory pathways.<a class="elsevierStyleCrossRef" href="#bib0170">4</a>Although they are very useful in routine hearing assessments, conventional or conditioned tonal audiometry, which are used to assess hearing acuity, and the battery of tests used to assess central auditory processing have limited clinical applicability for individuals with ASD because they require active responses from the patient. Individuals with ASD are not always able to respond accurately to the stimuli presented and/or perform the necessary tasks.Consequently, it is important to include electrophysiological tests in the assessment of individuals with ASD. Such tests may be able to both predict the hearing threshold of these individuals and to identify possible changes in the central auditory pathways, thus aiding in diagnosis and early intervention.Of the tests used for the electrophysiological assessment of hearing, brainstem auditory evoked potentials (BAEPs) are able to reflect synchronized electrical activity of the brainstem's neural elements in response to acoustic stimulation, and this neuronal activity can be observed in the first milliseconds after the presentation of the sound stimulus.<a class="elsevierStyleCrossRefs" href="#bib0175">5,6</a>Two types of acoustic stimuli can be used to elicit electrophysiological responses: verbal and nonverbal. These stimuli have different characteristics and elicit different responses; verbal stimuli are composed of a more complex temporal structure, and the response to these stimuli requires synchronic neuronal activation.<a class="elsevierStyleCrossRef" href="#bib0185">7</a> The perception of these acoustic characteristics is related to neural encoding, an essential function of the central auditory nervous system, which must simultaneously process multiple cues to decode a linguistic message.<a class="elsevierStyleCrossRef" href="#bib0190">8</a>Several studies have evaluated the role of the auditory pathway at the level of the brainstem in individuals with ASD using BAEPs.<a class="elsevierStyleCrossRefs" href="#bib0170">4,9–17</a> In general, the literature demonstrates that this population may present alterations in BAEPs; the most common findings are increased latency of waves III and V<a class="elsevierStyleCrossRefs" href="#bib0170">4,9,10</a> and an increase in the interpeak intervals for I–III and I–V, suggesting damage to the brainstems of these patients.<a class="elsevierStyleCrossRefs" href="#bib0170">4,10,12,13</a> However, these studies have evaluated this population using only one type of acoustic stimuli: clicks. The results have differed, however, and more studies are needed in this area to strengthen the hypotheses.As the assessment of sound information processing is of interest to scientific research in this population, the present study is innovative in its assessment of BAEPs with both verbal and nonverbal stimuli in individuals with ASD. This research is of great importance because it can reflect the changes in sound conduction via the central auditory pathways, allowing a better understanding of acoustic information processing. The present study used two different types of stimuli; it makes an important contribution to the literature because only one previous study compared both stimulus types. Although it is not a pioneering study on the subject, most previous studies of BAEPs in ASD used only nonverbal stimuli.Considering that individuals with ASD are hypo- or hypersensitive to sounds, the hypothesis of this study is this population will present abnormalities in BAEPs with both speech and click stimuli. Thus, this study aimed to analyze the neural encoding of verbal and nonverbal stimuli in individuals with ASD using BAEPs.Materials and methodsThis was a prospective, cross-sectional clinical study approved by the Research Ethics Committee under number 227/15. All subjects who participated in the survey and their parents received explanations and signed informed consent forms.SampleThe study included 30 individuals aged between 7 and 12 years and of both genders. The sample was divided into two groups:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•ASD group: A total of 26 families of individuals diagnosed with ASD were initially contacted. Of these, only 15 individuals participated and were able to complete all assessments (two females and 13 males, with a mean age of 9.07±1.75 years). All the individuals with ASD were diagnosed by psychiatrists and neurologists according to the DSM-IV criteria. The Autism Behavior Checklist was used to guarantee the homogeneity of the group, and the participating individuals scored between 75 and 85. The Wisconsin Card Sorting Test was used to assess cognitive development; the results were analyzed by an experienced psychologist and indicated performance around the low limits of normal development. All the individuals with ASD communicated verbally with major deficits in the functional use of language. The absence of any neurological disorder (such as seizures and/or syndromes) was an inclusion criterion.</li><li class="elsevierStyleListItem" id="lsti0010">•Typical development group (TD): This group comprised 15 normal, healthy individuals who were matched by age and gender to the ASD group. They did not present any psychiatric disorders, neurological antecedents, or auditory and/or speech or language complaints, and were spontaneously and voluntarily recruited.</li></ul>In addition to the abovementioned inclusion criteria, only children with normal hearing were considered. To rule out possible hearing loss, an initial anamnesis was conducted with the parent or guardian to investigate the individual's medical history, and meatoscopy was performed to rule out possible obstruction of the external ear canal.Subsequently, the following procedures were performed, and the following normality criteria were applied:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">•Acoustic immittance measurement: Tympanometry was performed using an AT235 (Interacoustics®, AT235, Denmark) with ipsilateral and contralateral acoustic reflex analysis at frequencies of 0.5, 1, 2, and 4kHz. The inclusion criterion was the presence of a type A curve with acoustic reflexes.</li><li class="elsevierStyleListItem" id="lsti0020">•Pure tone audiometry: A audiometer (Grason-Stadler®, GSI 6, USA) was used. This was performed at frequencies of 0.5, 1, 2, and 4kHz, and in some cases, play conditioning was used. The accepted normality criterion was an audibility threshold of up to 20dB HL for all measured frequencies.</li><li class="elsevierStyleListItem" id="lsti0025">•Speech audiometry: A audiometer (Grason-Stadler®, GSI 6, USA) was used. The speech recognition threshold (SRT) and the speech recognition percentage index (SRPI) were assessed using the word lists suggested by Santos and Russo.<a class="elsevierStyleCrossRef" href="#bib0240">18</a> The normality criteria were an SRT of up to 10dB HL above the mean pure tone threshold for the frequencies of 0.5, 1, and 2kHz; for the SRPI, more than 88% correct responses at an intensity of 30dB above the SRT was considered acceptable.</li></ul>All tests were conducted in a soundproof booth, and the sound stimuli were presented through supra-aural headphones.ProceduresElectrophysiological hearing assessments were performed using the Smart EP USB Junior (Intelligent Hearing System 5020, USA) in an acoustically treated room with the subject sitting comfortably in a reclining chair.The participant's skin was cleansed with abrasive paste, and the electrodes were placed using electrolytic paste and microporous tape according to the IES 10-20 international standard.<a class="elsevierStyleCrossRef" href="#bib0245">19</a> The impedance values of the electrodes were maintained below 5kΩ. BAEPs were measured using click and speech stimuli transmitted via insert earphones.BAEPs with a click stimulus were performed with rarefied polarity at 80dB HL and were presented at a rate of 27.7 stimuli per second for a total of 2048 stimuli. The recording window was 24ms. Two tests were performed on each ear so that reproducibility of the trace and, consequently, the presence of the response could be verified. After the traces were collected, the absolute latencies of waves I, III, and V, and interpeak intervals I–III, III–V, and I–V were identified and analyzed.BAEPs with speech stimuli were performed using the syllable /da/, which was delivered to the right ear only at an intensity of 80dB HL, a rate of 11.1 stimuli per second and a recording window of 60ms. Two sweeps of 3000 stimuli were performed for a total of 6000 stimuli. After collection, the traces were summed; in the trace resulting from this sum, the absolute latencies of waves V, A, C, D, E, F, and O and the V-A amplitude were identified and analyzed.After the data were collected, they were submitted to descriptive and inferential statistical analyses. For the BAEPs with a click stimulus, the descriptive analysis was performed using summary measures for the absolute latencies of waves I, III, and V in milliseconds (ms) and for interpeak intervals I–III, III–V, and I–V in microvolts by ear (right and left) and by group (TD and ASD). In the inferential analysis, each latency and interpeak interval was analyzed using an adjusted normal mixed model in which the patient effect was considered random and group and ear effects were considered fixed.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> For each model, the diagnostic analysis showed that the adjusted model performed well.<a class="elsevierStyleCrossRef" href="#bib0255">21</a>A significance level of 0.05 was adopted for each hypothesis test. First, the hypothesis that there was no interaction effect between group and ear was tested. When this hypothesis was not rejected (p-value >0.05), the hypotheses that there were no group or ear effects were tested.For the BAEPs with speech stimulus, the equality of the two groups’ means for all variables was tested using Student's t-test for two independent samples with the same variance.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> Homoscedasticity and normality assumptions were verified and were shown to be satisfied.ResultsThe BAEP results were analyzed using descriptive measures for the absolute latency of waves I, III, and V in the right and left ears of both groups (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>For each of the absolute latencies of waves I, III, and V, an adjusted model that took into account the group and ear variables was applied. The interactions between these variables for each wave (p-values of 0.783, 0.606, and 0.179 for waves I, III and V, respectively) were compared for each group irrespective of ear and for both ears irrespective of group.There was evidence of an ear effect; the mean absolute latency of wave I in the right ear was greater than that of the left ear (p-value=0.037) irrespective of group; the mean absolute latencies of waves III and V did not differ between ears (p-values of 0.326 and 0.613, respectively).There was no evidence of a group effect; the mean absolute latencies of waves I, III, and V did not differ between groups (p-values of 0.666, 0.682, and 0.211, respectively) for either the right or left ear.For interpeak intervals I–III, III–V, and IV, a descriptive analysis was performed on the right and left ears for both groups (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Similar to the method used for the latencies, the inferential analysis of interpeak intervals I–III, III–V, and I–V used an adjusted model that took into account the group and ear variables. As there was no interaction among these variables (p-values of 0.634, 0.107, and 0.099 for interpeak intervals I–III, III–V, and I–V, respectively), the ears were compared irrespective of group, and the groups were compared irrespective of ear.The results showed evidence of a group effect. The mean of interpeak interval III–V in the ASD group was greater than that of the TD group (p-value=0.046). The means of interpeak intervals I–III and I–V did not differ between the two groups (p-values of 0.368 and 0.332, respectively). Interpeak intervals I–III, III–V, and I–V did not differ between the ears (p-values of 0.261, 0.918, and 0.069, respectively).For the BAEPs with speech stimulus, descriptive measures were performed for the absolute latencies of waves V, A, C, D, E, F, and O, and the V-A amplitude in both groups (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Significant differences were observed between the two groups only for the absolute latency of wave V (p-value=0.011), and the mean of the TD group was longer than that of the ASD group.DiscussionBAEPs are objective measures that do not require the individual's active response. Consequently, one of the main clinical applications of BAEPs is the assessment of populations that are difficult to assess using behavioral methods, such as individuals with neurological and psychiatric disorders, including children with ASD.<a class="elsevierStyleCrossRefs" href="#bib0170">4,6</a>This study aimed to analyze the neural encoding of verbal and nonverbal stimuli of individuals with ASD using the BAEPs. To that end, BAEPs were elicited using click and speech stimuli in a group of children with ASD, and the results were compared with those of TD children.Regarding the BAEPs elicited by click stimuli, no differences were observed between the absolute wave latency values of individuals with ASD and TD children. Regarding the interpeak intervals, there was a group effect for interpeak interval III–V, for which the ASD group showed greater values than the TD group.The scientific literature is inconsistent regarding BAEP findings. Some studies confirm the lack of changes in the absolute wave latencies of BAEPs<a class="elsevierStyleCrossRefs" href="#bib0210">12,15–17</a>; however, other authors have found an increase in the absolute latencies of waves III and IV,<a class="elsevierStyleCrossRef" href="#bib0195">9</a> an increase in the latencies of waves I and V,<a class="elsevierStyleCrossRef" href="#bib0200">10</a> and increased latencies of wave V in the right ear and wave I in the left ear in individuals with ASD.<a class="elsevierStyleCrossRef" href="#bib0265">23</a>The dysfunctions observed along the auditory pathway in individuals with ASD have also been highlighted in other studies that observed changes in the interpeak intervals. One study that assessed children with ASD also found changes only in the III–V interpeak interval in these children compared with children with TD.<a class="elsevierStyleCrossRef" href="#bib0210">12</a> Other studies have also observed increases in this interpeak interval, along with other changes.<a class="elsevierStyleCrossRefs" href="#bib0200">10,12,13,23</a>Additional studies have found changes interpeak intervals other than those observed in this study, such interpeak interval III–IV,<a class="elsevierStyleCrossRef" href="#bib0195">9</a> interpeak intervals I–III and I–V,<a class="elsevierStyleCrossRef" href="#bib0225">15</a> and interpeak interval I–III.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> In contrast, other studies have reported no statistically significant changes in BAEPs with click stimuli in individuals with ASD.<a class="elsevierStyleCrossRefs" href="#bib0230">16,17</a>Considering the findings described in the literature, it can be determined that individuals with ASD may have a distinct pattern of sound transmission throughout the nervous system; additionally, some studies describe alterations in the lower and/or upper brainstem; despite this, an extended onset of wave V has been demonstrated to be the most frequent alteration among individuals with ASD. Although the results of the present study show normal absolute latency for wave V, the increase in the III–V interpeak interval is also suggestive of a possible change in the upper brainstem region in these individuals.The changes in the latency values, interpeak intervals, and wave amplitudes of BAEPs are known to reflect changes in the myelinationi, axon diameter, and synaptic efficacy of the auditory pathways at the brainstem level.<a class="elsevierStyleCrossRefs" href="#bib0275">25,26</a> Thus, the results of this study suggest that children with ASD exhibit abnormal cortical structures at the brainstem level, which impairs the conduction of neuroelectrical impulses of nonverbal stimuli between the cochlear nuclei and the lateral lemniscus.Regarding the BAEPs elicited by speech stimuli, a statistically significant difference was found between the two groups in the absolute latency of wave V, which was shorter in the ASD group than in the TD group. However, the absolute latencies of waves A, C, D, E, F, and O, and the V-A amplitude showed no statistically significant differences between the groups.Speech stimuli are complex and consist of numerous acoustic characteristics.<a class="elsevierStyleCrossRef" href="#bib0190">8</a> To capture these signals, encoding must occur at the beginning of the stimulus in the brainstem.<a class="elsevierStyleCrossRef" href="#bib0185">7</a>Some individuals with ASD may be hypersensitive to sounds and other sensory stimuli, which may make them more sensitive to the acoustic characteristics of a sound. This hypersensitivity could explain the decrease in the latency of wave V in the ASD group, which suggests faster neural encoding of the initial portion (onset) of the speech stimulus. This possible hyperresponsiveness to processing the immediate start of the acoustic stimulus does not seem to be sustained through the end of the stimulus (offset), as this difference was not observed for the other components (waves A, C, D, E, F, and O).<a class="elsevierStyleCrossRef" href="#bib0165">3</a>The findings of this study differ from those of another study in which absolute latencies of waves V, A, C, and F of the BAEPs were longer in the ASD group than in the TD group.<a class="elsevierStyleCrossRef" href="#bib0285">27</a>A study using click and speech stimuli in children with ASD found that the children with ASD had normal BAEPs in response to click stimuli; however, when speech stimuli were used, approximately 20% of the children with ASD exhibited aberrant encoding compared to controls. The authors suggested that speech stimuli were more sensitive than click stimuli for detecting subtle difficulties in language processing.<a class="elsevierStyleCrossRef" href="#bib0290">28</a>This variation was not considered in all of the comparative studies above, which may have resulted in a very heterogeneous research sample. Currently, individuals with ASD can be subdivided into low- and high-functioning groups.<a class="elsevierStyleCrossRef" href="#bib0275">25</a> This variation was not considered in all of the comparative studies above, which may have resulted in a very heterogeneous research sample. Furthermore, the discrepancies in the results could be due to differences in the mechanisms of auditory pathway dysfunction in along the spectrum of this disorder or to differences in the mechanisms used to process stimuli (click versus speech).<a class="elsevierStyleCrossRefs" href="#bib0295">29,30</a>The present study drew participants from a single center and was performed with a small sample; thus, the generalization of its findings is limited. Therefore, future studies should perform electrophysiological examinations of hearing in a greater number of individuals with ASD and should use these potentials to investigate neuronal plasticity in advance of therapeutic intervention.FundingThis research was funded by São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP 2015/13239-7).Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1344001" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1236828" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1344000" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodologia" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1236827" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedures" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-08-08" "fechaAceptado" => "2018-12-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1236828" "palabras" => array:3 [ 0 => "Autistic disorder" 1 => "Electrophysiology" 2 => "Auditory evoked potentials" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1236827" "palabras" => array:3 [ 0 => "Transtorno autista" 1 => "Eletrofisiologia" 2 => "Potenciais evocados auditivos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesThis study aimed to analyze the neural encoding of verbal and nonverbal stimuli in individuals with autism spectrum disorder using brainstem auditory evoked potentials. MethodologyThirty individuals between 7 and 12 years of age and of both genders participated in this study. Fifteen were diagnosed with autism spectrum disorder, and 15 had typical development. All subjects had normal hearing and no other impairments. An electrophysiological hearing assessment was performed using brainstem auditory evoked potentials with click and speech stimuli. ResultsIn the brainstem auditory evoked potentials with click stimuli, the mean wave I latency was longer for the right ear in both groups, and interpeak intervals III–V were greater for the individuals with autism spectrum disorder. For brainstem auditory evoked potentials with speech stimuli, wave V latency was shorter in individuals with autism spectrum disorder. ConclusionThese data suggest that individuals with autism spectrum disorder may have a dysfunction of the central auditory nervous system for nonverbal stimuli and faster neural encoding of the initial part of the verbal stimulus, suggesting hypersensitivity to complex sounds such as speech." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivosEste estudo visou analisar a codificação neural de estímulos verbais e não verbais em indivíduos com transtorno do espectro do autismo com o uso de potenciais evocados auditivos de tronco encefálico. MetodologiaParticiparam 30 indivíduos entre sete e 12 anos e de ambos os sexos; 15 foram diagnosticados com transtorno do espectro do autismo e 15 apresentaram desenvolvimento típico. Todos os indivíduos apresentaram audição normal e nenhuma outra alteração. Foi feita uma avaliação eletrofisiológica da audição com o uso dos potenciais evocados auditivos de tronco encefálico com estímulos de clique e fala. ResultadosNos potenciais evocados auditivos de tronco encefálico com estímulos de clique, a média do valor de latência da onda I foi maior para o ouvido direito nos dois grupos e os intervalos interpicos III-V foram maiores para os indivíduos com transtorno do espectro do autismo. Para os potenciais evocados auditivos de tronco encefálico com estímulos de fala, a latência da onda V foi menor nos indivíduos com transtorno do espectro do autismo. ConclusãoNossos dados sugerem que os indivíduos com transtorno do espectro do autismo podem ter uma disfunção do sistema nervoso auditivo central para estímulos não verbais e codificação neural mais rápida da parte inicial dos estímulos verbais, o que sugere hipersensibilidade a sons complexos, como a fala." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodologia" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Kamita MK, Silva LA, Magliaro FC, Kawai RY, Fernandes FD, Matas CG. Brainstem auditory evoked potentials in children with autism spectrum disorder. J Pediatr (Rio J). 2020;96:386–92." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Study conducted at the Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1372 "Ancho" => 2500 "Tamanyo" => 167859 ] ] "descripcion" => array:1 [ "en" => "Descriptive measures of wave latencies I, III, and V (ms) of BAEPs with click stimulus, by group and ear. ASD, autism spectrum disorders; TD, typical development; ms, milliseconds." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1247 "Ancho" => 2292 "Tamanyo" => 130672 ] ] "descripcion" => array:1 [ "en" => "Descriptive measures of interpeaks I–III, III–V, and I–V (ms) of BAEPs with click stimulus, by group and ear. ASD, autism spectrum disorders; TD, typical development; μV, microvolts." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1907 "Ancho" => 2283 "Tamanyo" => 260414 ] ] "descripcion" => array:1 [ "en" => "Descriptive measures of wave latencies V, A, C, D, E, F, and O and the V-A amplitude of BAEPs with speech stimulus, by group and ear. ASD, autism spectrum disorders; TD, typical development; ms, milliseconds; μV, microvolts." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autistic disturbances of affective contact" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Kanner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nervous Child" "fecha" => "1943" "volumen" => "2" "paginaInicial" => "217" "paginaFinal" => "250" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manual Diagnóstico e Estatístico de Transtornos Mentais. 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Potenciais evocados auditivos de tronco encefálico em crianças com transtorno do espectro do autismo

Mariana Keiko Kamita

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marikeikokamita@gmail.com

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, Liliane Aparecida Fagundes Silva, Fernanda Cristina Leite Magliaro, Rebeca Yuko Couto Kawai, Fernanda Dreux Miranda Fernandes, Carla Gentile Matas

Universidade de São Paulo (USP), Faculdade de Medicina (FM), Departamento de Terapia Física, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Autism spectrum disorder &#40;ASD&#41; is a central disorder characterized by the inability to establish interpersonal relationships and to react normally to situations early in life&#44; with an emphasis on social withdrawal&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the Diagnostic and Statistical Manual of Mental Disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> individuals with ASD may exhibit behavioral patterns that include restricted interests and repetitive and stereotyped behaviors&#46; Furthermore&#44; changes in reciprocal social interactions and modes of communication are observed&#46; Additionally&#44; it is known that individuals with ASD may have perceptual&#44; cognitive&#44; and memory disorders of attention that can be mistaken for auditory deficiencies&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Moreover&#44; individuals with ASD may be hyper- or hyposensitive to sensory stimuli and can be very sensitive to sounds&#59; they may be troubled by loud sounds &#40;hyperacusis&#41; or be unable to hear and respond to loud sounds or noises &#40;hypoacusis&#41;&#46; Such sensitivities are also observed in relation to light and tactile sensation&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Consequently&#44; it is important to perform a complete audiological assessment that investigates both the peripheral and the central auditory pathways&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although they are very useful in routine hearing assessments&#44; conventional or conditioned tonal audiometry&#44; which are used to assess hearing acuity&#44; and the battery of tests used to assess central auditory processing have limited clinical applicability for individuals with ASD because they require active responses from the patient&#46; Individuals with ASD are not always able to respond accurately to the stimuli presented and&#47;or perform the necessary tasks&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Consequently&#44; it is important to include electrophysiological tests in the assessment of individuals with ASD&#46; Such tests may be able to both predict the hearing threshold of these individuals and to identify possible changes in the central auditory pathways&#44; thus aiding in diagnosis and early intervention&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of the tests used for the electrophysiological assessment of hearing&#44; brainstem auditory evoked potentials &#40;BAEPs&#41; are able to reflect synchronized electrical activity of the brainstem&#39;s neural elements in response to acoustic stimulation&#44; and this neuronal activity can be observed in the first milliseconds after the presentation of the sound stimulus&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Two types of acoustic stimuli can be used to elicit electrophysiological responses&#58; verbal and nonverbal&#46; These stimuli have different characteristics and elicit different responses&#59; verbal stimuli are composed of a more complex temporal structure&#44; and the response to these stimuli requires synchronic neuronal activation&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> The perception of these acoustic characteristics is related to neural encoding&#44; an essential function of the central auditory nervous system&#44; which must simultaneously process multiple cues to decode a linguistic message&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Several studies have evaluated the role of the auditory pathway at the level of the brainstem in individuals with ASD using BAEPs&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;9&#8211;17</span></a> In general&#44; the literature demonstrates that this population may present alterations in BAEPs&#59; the most common findings are increased latency of waves III and V<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> and an increase in the interpeak intervals for I&#8211;III and I&#8211;V&#44; suggesting damage to the brainstems of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;10&#44;12&#44;13</span></a> However&#44; these studies have evaluated this population using only one type of acoustic stimuli&#58; clicks&#46; The results have differed&#44; however&#44; and more studies are needed in this area to strengthen the hypotheses&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As the assessment of sound information processing is of interest to scientific research in this population&#44; the present study is innovative in its assessment of BAEPs with both verbal and nonverbal stimuli in individuals with ASD&#46; This research is of great importance because it can reflect the changes in sound conduction via the central auditory pathways&#44; allowing a better understanding of acoustic information processing&#46; The present study used two different types of stimuli&#59; it makes an important contribution to the literature because only one previous study compared both stimulus types&#46; Although it is not a pioneering study on the subject&#44; most previous studies of BAEPs in ASD used only nonverbal stimuli&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considering that individuals with ASD are hypo- or hypersensitive to sounds&#44; the hypothesis of this study is this population will present abnormalities in BAEPs with both speech and click stimuli&#46; Thus&#44; this study aimed to analyze the neural encoding of verbal and nonverbal stimuli in individuals with ASD using BAEPs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0055" class="elsevierStylePara elsevierViewall">This was a prospective&#44; cross-sectional clinical study approved by the Research Ethics Committee under number 227&#47;15&#46; All subjects who participated in the survey and their parents received explanations and signed informed consent forms&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample</span><p id="par0060" class="elsevierStylePara elsevierViewall">The study included 30 individuals aged between 7 and 12 years and of both genders&#46; The sample was divided into two groups&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">ASD group&#58; A total of 26 families of individuals diagnosed with ASD were initially contacted&#46; Of these&#44; only 15 individuals participated and were able to complete all assessments &#40;two females and 13 males&#44; with a mean age of 9&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;75 years&#41;&#46; All the individuals with ASD were diagnosed by psychiatrists and neurologists according to the DSM-IV criteria&#46; The Autism Behavior Checklist was used to guarantee the homogeneity of the group&#44; and the participating individuals scored between 75 and 85&#46; The Wisconsin Card Sorting Test was used to assess cognitive development&#59; the results were analyzed by an experienced psychologist and indicated performance around the low limits of normal development&#46; All the individuals with ASD communicated verbally with major deficits in the functional use of language&#46; The absence of any neurological disorder &#40;such as seizures and&#47;or syndromes&#41; was an inclusion criterion&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Typical development group &#40;TD&#41;&#58; This group comprised 15 normal&#44; healthy individuals who were matched by age and gender to the ASD group&#46; They did not present any psychiatric disorders&#44; neurological antecedents&#44; or auditory and&#47;or speech or language complaints&#44; and were spontaneously and voluntarily recruited&#46;</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition to the abovementioned inclusion criteria&#44; only children with normal hearing were considered&#46; To rule out possible hearing loss&#44; an initial anamnesis was conducted with the parent or guardian to investigate the individual&#39;s medical history&#44; and meatoscopy was performed to rule out possible obstruction of the external ear canal&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Subsequently&#44; the following procedures were performed&#44; and the following normality criteria were applied&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Acoustic immittance measurement&#58; Tympanometry was performed using an AT235 &#40;Interacoustics&#174;&#44; AT235&#44; Denmark&#41; with ipsilateral and contralateral acoustic reflex analysis at frequencies of 0&#46;5&#44; 1&#44; 2&#44; and 4<span class="elsevierStyleHsp" style=""></span>kHz&#46; The inclusion criterion was the presence of a type A curve with acoustic reflexes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Pure tone audiometry&#58; A audiometer &#40;Grason-Stadler&#174;&#44; GSI 6&#44; USA&#41; was used&#46; This was performed at frequencies of 0&#46;5&#44; 1&#44; 2&#44; and 4<span class="elsevierStyleHsp" style=""></span>kHz&#44; and in some cases&#44; play conditioning was used&#46; The accepted normality criterion was an audibility threshold of up to 20<span class="elsevierStyleHsp" style=""></span>dB HL for all measured frequencies&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Speech audiometry&#58; A audiometer &#40;Grason-Stadler&#174;&#44; GSI 6&#44; USA&#41; was used&#46; The speech recognition threshold &#40;SRT&#41; and the speech recognition percentage index &#40;SRPI&#41; were assessed using the word lists suggested by Santos and Russo&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> The normality criteria were an SRT of up to 10<span class="elsevierStyleHsp" style=""></span>dB HL above the mean pure tone threshold for the frequencies of 0&#46;5&#44; 1&#44; and 2<span class="elsevierStyleHsp" style=""></span>kHz&#59; for the SRPI&#44; more than 88&#37; correct responses at an intensity of 30<span class="elsevierStyleHsp" style=""></span>dB above the SRT was considered acceptable&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">All tests were conducted in a soundproof booth&#44; and the sound stimuli were presented through supra-aural headphones&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedures</span><p id="par0105" class="elsevierStylePara elsevierViewall">Electrophysiological hearing assessments were performed using the Smart EP USB Junior &#40;Intelligent Hearing System 5020&#44; USA&#41; in an acoustically treated room with the subject sitting comfortably in a reclining chair&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The participant&#39;s skin was cleansed with abrasive paste&#44; and the electrodes were placed using electrolytic paste and microporous tape according to the IES 10-20 international standard&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> The impedance values of the electrodes were maintained below 5<span class="elsevierStyleHsp" style=""></span>k&#937;&#46; BAEPs were measured using click and speech stimuli transmitted via insert earphones&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">BAEPs with a click stimulus were performed with rarefied polarity at 80<span class="elsevierStyleHsp" style=""></span>dB HL and were presented at a rate of 27&#46;7 stimuli per second for a total of 2048 stimuli&#46; The recording window was 24<span class="elsevierStyleHsp" style=""></span>ms&#46; Two tests were performed on each ear so that reproducibility of the trace and&#44; consequently&#44; the presence of the response could be verified&#46; After the traces were collected&#44; the absolute latencies of waves I&#44; III&#44; and V&#44; and interpeak intervals I&#8211;III&#44; III&#8211;V&#44; and I&#8211;V were identified and analyzed&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">BAEPs with speech stimuli were performed using the syllable &#47;da&#47;&#44; which was delivered to the right ear only at an intensity of 80<span class="elsevierStyleHsp" style=""></span>dB HL&#44; a rate of 11&#46;1 stimuli per second and a recording window of 60<span class="elsevierStyleHsp" style=""></span>ms&#46; Two sweeps of 3000 stimuli were performed for a total of 6000 stimuli&#46; After collection&#44; the traces were summed&#59; in the trace resulting from this sum&#44; the absolute latencies of waves V&#44; A&#44; C&#44; D&#44; E&#44; F&#44; and O and the V-A amplitude were identified and analyzed&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">After the data were collected&#44; they were submitted to descriptive and inferential statistical analyses&#46; For the BAEPs with a click stimulus&#44; the descriptive analysis was performed using summary measures for the absolute latencies of waves I&#44; III&#44; and V in milliseconds &#40;ms&#41; and for interpeak intervals I&#8211;III&#44; III&#8211;V&#44; and I&#8211;V in microvolts by ear &#40;right and left&#41; and by group &#40;TD and ASD&#41;&#46; In the inferential analysis&#44; each latency and interpeak interval was analyzed using an adjusted normal mixed model in which the patient effect was considered random and group and ear effects were considered fixed&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> For each model&#44; the diagnostic analysis showed that the adjusted model performed well&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">A significance level of 0&#46;05 was adopted for each hypothesis test&#46; First&#44; the hypothesis that there was no interaction effect between group and ear was tested&#46; When this hypothesis was not rejected &#40;<span class="elsevierStyleItalic">p</span>-value &#62;0&#46;05&#41;&#44; the hypotheses that there were no group or ear effects were tested&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">For the BAEPs with speech stimulus&#44; the equality of the two groups&#8217; means for all variables was tested using Student&#39;s <span class="elsevierStyleItalic">t</span>-test for two independent samples with the same variance&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Homoscedasticity and normality assumptions were verified and were shown to be satisfied&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0140" class="elsevierStylePara elsevierViewall">The BAEP results were analyzed using descriptive measures for the absolute latency of waves I&#44; III&#44; and V in the right and left ears of both groups &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">For each of the absolute latencies of waves I&#44; III&#44; and V&#44; an adjusted model that took into account the group and ear variables was applied&#46; The interactions between these variables for each wave &#40;<span class="elsevierStyleItalic">p</span>-values of 0&#46;783&#44; 0&#46;606&#44; and 0&#46;179 for waves I&#44; III and V&#44; respectively&#41; were compared for each group irrespective of ear and for both ears irrespective of group&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">There was evidence of an ear effect&#59; the mean absolute latency of wave I in the right ear was greater than that of the left ear &#40;<span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;037&#41; irrespective of group&#59; the mean absolute latencies of waves III and V did not differ between ears &#40;<span class="elsevierStyleItalic">p</span>-values of 0&#46;326 and 0&#46;613&#44; respectively&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">There was no evidence of a group effect&#59; the mean absolute latencies of waves I&#44; III&#44; and V did not differ between groups &#40;<span class="elsevierStyleItalic">p</span>-values of 0&#46;666&#44; 0&#46;682&#44; and 0&#46;211&#44; respectively&#41; for either the right or left ear&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">For interpeak intervals I&#8211;III&#44; III&#8211;V&#44; and IV&#44; a descriptive analysis was performed on the right and left ears for both groups &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Similar to the method used for the latencies&#44; the inferential analysis of interpeak intervals I&#8211;III&#44; III&#8211;V&#44; and I&#8211;V used an adjusted model that took into account the group and ear variables&#46; As there was no interaction among these variables &#40;<span class="elsevierStyleItalic">p</span>-values of 0&#46;634&#44; 0&#46;107&#44; and 0&#46;099 for interpeak intervals I&#8211;III&#44; III&#8211;V&#44; and I&#8211;V&#44; respectively&#41;&#44; the ears were compared irrespective of group&#44; and the groups were compared irrespective of ear&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The results showed evidence of a group effect&#46; The mean of interpeak interval III&#8211;V in the ASD group was greater than that of the TD group &#40;<span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41;&#46; The means of interpeak intervals I&#8211;III and I&#8211;V did not differ between the two groups &#40;<span class="elsevierStyleItalic">p</span>-values of 0&#46;368 and 0&#46;332&#44; respectively&#41;&#46; Interpeak intervals I&#8211;III&#44; III&#8211;V&#44; and I&#8211;V did not differ between the ears &#40;<span class="elsevierStyleItalic">p</span>-values of 0&#46;261&#44; 0&#46;918&#44; and 0&#46;069&#44; respectively&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">For the BAEPs with speech stimulus&#44; descriptive measures were performed for the absolute latencies of waves V&#44; A&#44; C&#44; D&#44; E&#44; F&#44; and O&#44; and the V-A amplitude in both groups &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Significant differences were observed between the two groups only for the absolute latency of wave V &#40;<span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#44; and the mean of the TD group was longer than that of the ASD group&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">BAEPs are objective measures that do not require the individual&#39;s active response&#46; Consequently&#44; one of the main clinical applications of BAEPs is the assessment of populations that are difficult to assess using behavioral methods&#44; such as individuals with neurological and psychiatric disorders&#44; including children with ASD&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;6</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">This study aimed to analyze the neural encoding of verbal and nonverbal stimuli of individuals with ASD using the BAEPs&#46; To that end&#44; BAEPs were elicited using click and speech stimuli in a group of children with ASD&#44; and the results were compared with those of TD children&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Regarding the BAEPs elicited by click stimuli&#44; no differences were observed between the absolute wave latency values of individuals with ASD and TD children&#46; Regarding the interpeak intervals&#44; there was a group effect for interpeak interval III&#8211;V&#44; for which the ASD group showed greater values than the TD group&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The scientific literature is inconsistent regarding BAEP findings&#46; Some studies confirm the lack of changes in the absolute wave latencies of BAEPs<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;15&#8211;17</span></a>&#59; however&#44; other authors have found an increase in the absolute latencies of waves III and IV&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> an increase in the latencies of waves I and V&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> and increased latencies of wave V in the right ear and wave I in the left ear in individuals with ASD&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">The dysfunctions observed along the auditory pathway in individuals with ASD have also been highlighted in other studies that observed changes in the interpeak intervals&#46; One study that assessed children with ASD also found changes only in the III&#8211;V interpeak interval in these children compared with children with TD&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Other studies have also observed increases in this interpeak interval&#44; along with other changes&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;12&#44;13&#44;23</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Additional studies have found changes interpeak intervals other than those observed in this study&#44; such interpeak interval III&#8211;IV&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> interpeak intervals I&#8211;III and I&#8211;V&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> and interpeak interval I&#8211;III&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> In contrast&#44; other studies have reported no statistically significant changes in BAEPs with click stimuli in individuals with ASD&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Considering the findings described in the literature&#44; it can be determined that individuals with ASD may have a distinct pattern of sound transmission throughout the nervous system&#59; additionally&#44; some studies describe alterations in the lower and&#47;or upper brainstem&#59; despite this&#44; an extended onset of wave V has been demonstrated to be the most frequent alteration among individuals with ASD&#46; Although the results of the present study show normal absolute latency for wave V&#44; the increase in the III&#8211;V interpeak interval is also suggestive of a possible change in the upper brainstem region in these individuals&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The changes in the latency values&#44; interpeak intervals&#44; and wave amplitudes of BAEPs are known to reflect changes in the myelinationi&#44; axon diameter&#44; and synaptic efficacy of the auditory pathways at the brainstem level&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#44;26</span></a> Thus&#44; the results of this study suggest that children with ASD exhibit abnormal cortical structures at the brainstem level&#44; which impairs the conduction of neuroelectrical impulses of nonverbal stimuli between the cochlear nuclei and the lateral lemniscus&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Regarding the BAEPs elicited by speech stimuli&#44; a statistically significant difference was found between the two groups in the absolute latency of wave V&#44; which was shorter in the ASD group than in the TD group&#46; However&#44; the absolute latencies of waves A&#44; C&#44; D&#44; E&#44; F&#44; and O&#44; and the V-A amplitude showed no statistically significant differences between the groups&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Speech stimuli are complex and consist of numerous acoustic characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> To capture these signals&#44; encoding must occur at the beginning of the stimulus in the brainstem&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Some individuals with ASD may be hypersensitive to sounds and other sensory stimuli&#44; which may make them more sensitive to the acoustic characteristics of a sound&#46; This hypersensitivity could explain the decrease in the latency of wave V in the ASD group&#44; which suggests faster neural encoding of the initial portion &#40;onset&#41; of the speech stimulus&#46; This possible hyperresponsiveness to processing the immediate start of the acoustic stimulus does not seem to be sustained through the end of the stimulus &#40;offset&#41;&#44; as this difference was not observed for the other components &#40;waves A&#44; C&#44; D&#44; E&#44; F&#44; and O&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The findings of this study differ from those of another study in which absolute latencies of waves V&#44; A&#44; C&#44; and F of the BAEPs were longer in the ASD group than in the TD group&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">A study using click and speech stimuli in children with ASD found that the children with ASD had normal BAEPs in response to click stimuli&#59; however&#44; when speech stimuli were used&#44; approximately 20&#37; of the children with ASD exhibited aberrant encoding compared to controls&#46; The authors suggested that speech stimuli were more sensitive than click stimuli for detecting subtle difficulties in language processing&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">This variation was not considered in all of the comparative studies above&#44; which may have resulted in a very heterogeneous research sample&#46; Currently&#44; individuals with ASD can be subdivided into low- and high-functioning groups&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> This variation was not considered in all of the comparative studies above&#44; which may have resulted in a very heterogeneous research sample&#46; Furthermore&#44; the discrepancies in the results could be due to differences in the mechanisms of auditory pathway dysfunction in along the spectrum of this disorder or to differences in the mechanisms used to process stimuli &#40;click versus speech&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">The present study drew participants from a single center and was performed with a small sample&#59; thus&#44; the generalization of its findings is limited&#46; Therefore&#44; future studies should perform electrophysiological examinations of hearing in a greater number of individuals with ASD and should use these potentials to investigate neuronal plasticity in advance of therapeutic intervention&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0260" class="elsevierStylePara elsevierViewall">This research was funded by <span class="elsevierStyleGrantSponsor" id="gs1">S&#227;o Paulo Research Foundation</span> &#40;Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo &#8211; <span class="elsevierStyleGrantNumber" refid="gs1">FAPESP 2015&#47;13239-7</span>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0265" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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          "clase" => "keyword"
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            0 => "Autistic disorder"
            1 => "Electrophysiology"
            2 => "Auditory evoked potentials"
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          "palabras" => array:3 [
            0 => "Transtorno autista"
            1 => "Eletrofisiologia"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to analyze the neural encoding of verbal and nonverbal stimuli in individuals with autism spectrum disorder using brainstem auditory evoked potentials&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty individuals between 7 and 12 years of age and of both genders participated in this study&#46; Fifteen were diagnosed with autism spectrum disorder&#44; and 15 had typical development&#46; All subjects had normal hearing and no other impairments&#46; An electrophysiological hearing assessment was performed using brainstem auditory evoked potentials with click and speech stimuli&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the brainstem auditory evoked potentials with click stimuli&#44; the mean wave I latency was longer for the right ear in both groups&#44; and interpeak intervals III&#8211;V were greater for the individuals with autism spectrum disorder&#46; For brainstem auditory evoked potentials with speech stimuli&#44; wave V latency was shorter in individuals with autism spectrum disorder&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">These data suggest that individuals with autism spectrum disorder may have a dysfunction of the central auditory nervous system for nonverbal stimuli and faster neural encoding of the initial part of the verbal stimulus&#44; suggesting hypersensitivity to complex sounds such as speech&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este estudo visou analisar a codifica&#231;&#227;o neural de est&#237;mulos verbais e n&#227;o verbais em indiv&#237;duos com transtorno do espectro do autismo com o uso de potenciais evocados auditivos de tronco encef&#225;lico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodologia</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Participaram 30 indiv&#237;duos entre sete e 12 anos e de ambos os sexos&#59; 15 foram diagnosticados com transtorno do espectro do autismo e 15 apresentaram desenvolvimento t&#237;pico&#46; Todos os indiv&#237;duos apresentaram audi&#231;&#227;o normal e nenhuma outra altera&#231;&#227;o&#46; Foi feita uma avalia&#231;&#227;o eletrofisiol&#243;gica da audi&#231;&#227;o com o uso dos potenciais evocados auditivos de tronco encef&#225;lico com est&#237;mulos de clique e fala&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Nos potenciais evocados auditivos de tronco encef&#225;lico com est&#237;mulos de clique&#44; a m&#233;dia do valor de lat&#234;ncia da onda I foi maior para o ouvido direito nos dois grupos e os intervalos interpicos III-V foram maiores para os indiv&#237;duos com transtorno do espectro do autismo&#46; Para os potenciais evocados auditivos de tronco encef&#225;lico com est&#237;mulos de fala&#44; a lat&#234;ncia da onda V foi menor nos indiv&#237;duos com transtorno do espectro do autismo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nossos dados sugerem que os indiv&#237;duos com transtorno do espectro do autismo podem ter uma disfun&#231;&#227;o do sistema nervoso auditivo central para est&#237;mulos n&#227;o verbais e codifica&#231;&#227;o neural mais r&#225;pida da parte inicial dos est&#237;mulos verbais&#44; o que sugere hipersensibilidade a sons complexos&#44; como a fala&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Kamita MK&#44; Silva LA&#44; Magliaro FC&#44; Kawai RY&#44; Fernandes FD&#44; Matas CG&#46; Brainstem auditory evoked potentials in children with autism spectrum disorder&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;386&#8211;92&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Universidade de S&#227;o Paulo&#44; Faculdade de Medicina&#44; Departamento de Fisioterapia&#44; Fonoaudiologia e Terapia Ocupacional&#44; S&#227;o Paulo&#44; SP&#44; Brazil&#46;</p>"
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2018.12.010

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Year/Month	Html	Pdf	Total

2024 November	9	3	12
2024 October	23	22	45
2024 September	37	32	69
2024 August	44	44	88
2024 July	42	60	102
2024 June	44	34	78
2024 May	56	21	77
2024 April	31	28	59
2024 March	31	19	50
2024 February	28	31	59
2024 January	18	29	47
2023 December	21	21	42
2023 November	27	32	59
2023 October	37	39	76
2023 September	24	40	64
2023 August	20	18	38
2023 July	21	12	33
2023 June	16	18	34
2023 May	26	18	44
2023 April	23	16	39
2023 March	59	21	80
2023 February	18	11	29
2023 January	20	23	43
2022 December	56	24	80
2022 November	26	26	52
2022 October	43	42	85
2022 September	24	42	66
2022 August	34	41	75
2022 July	22	39	61
2022 June	23	24	47
2022 May	32	29	61
2022 April	28	32	60
2022 March	22	40	62
2022 February	18	22	40
2022 January	18	17	35
2021 December	20	15	35
2021 November	13	18	31
2021 October	10	15	25
2021 September	10	14	24
2021 August	15	9	24
2021 July	9	5	14
2021 June	19	7	26
2021 May	28	16	44
2021 April	56	17	73
2021 March	50	12	62
2021 February	30	10	40
2021 January	22	8	30
2020 December	31	12	43
2020 November	15	12	27
2020 October	15	6	21
2020 September	24	16	40
2020 August	73	14	87
2020 July	58	20	78
2020 June	16	13	29
2020 May	14	4	18
2020 April	21	19	40
2020 March	4	18	22
2020 February	12	17	29
2020 January	15	18	33
2019 December	7	8	15
2019 November	6	4	10
2019 October	5	14	19
2019 September	7	8	15
2019 August	5	9	14
2019 July	3	7	10
2019 June	9	8	17
2019 May	2	8	10
2019 April	6	15	21
2019 March	4	5	9

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