Autism spectrum disorder: importance of audiology
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* Chantal Kealey

As Director of Audiology for the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA), I read with great interest, the *CMAJ* article on autism spectrum disorder by Anagnostou and colleagues.1 Congratulations to the authors.

The CASLPA is a national professional association that represents more than 6000 speech-language pathologists, audiologists and supportive personnel — many of whom work closely, and daily, with patients or clients affected by autism spectrum disorder. Anagnostou and colleagues1 have done a commendable job of noting the role of speech-language pathologists and the importance of comprehensive assessment and intervention of communication disorders. However, the importance of a comprehensive audiologic assessment was overlooked and was particularly missed in the section that outlines best practice for clinical work-up for autism spectrum disorder. Box 4 in the article,1 which lists red flags for autism, includes indices for delayed or atypical language. Some of these red flags are also signs of possible hearing loss.

Although there are challenges involved in providing diagnoses for young children, advances in auditory physiologic testing permit audiologists to assess auditory function with accuracy in young children.

I understand that not all professions that may affect the diagnosis of autism spectrum disorder could be listed in this article; however, I strongly believe that audiologists play too valuable a role on the interprofessional team to be excluded. Determining auditory function is a fundamental, necessary step in diagnosing and providing interventions for autism spectrum disorder. I respectfully suggest that more reference to audiologic assessment be included as part of the best practice model for diagnosing autism spectrum disorder.

## Reference

1.  Anagnostou E, Zwaigenbaum L, Szatmari P, et al. Autism spectrum disorder: advances in evidence-based practice. CMAJ 2014; Jan. 13. [Epub ahead of print].