Otitis Media and Expressive Language Outcomes Across Toddlers with ASDs, Language Delays, and Typical Development

Background: Research indicates that children with autism spectrum disorders (ASDs) experience otitis media at higher rates than typically developing children (Niehus & Lord, 2006).  This is particularly concerning given that children with ASDs are already at heightened risk for long-term language impairments, and recurrent otitis media is associated with poorer speech and language outcomes among typically developing children (Teele et al., 1984).  Additionally, the presence of temporary hearing impairment due to fluid obstruction in the middle ear may complicate the diagnostic evaluations by negatively impacting a child’s social engagement.  A deeper understanding of the incidence of recurrent otitis media (ROM) across different populations and correlates ROM within those populations would be informative for both physicians selecting medical treatments and early intervention specialists attempting to evaluate children and recommend interventions.  

Objectives:   1. To compare the incidence of ROM across children with ASDs, language delays, and typical development 2. To examine the relationship between ROM and expressive language outcomes within each group.

Methods:   Toddlers (n=197) screened positive on the Modified Checklist for Autism in Toddlers (-Revised) (M-CHAT(-R); Robins et al., 1999, 2009) or were flagged by their pediatrician for possible ASD. Evaluations included ADOS, Vineland Adaptive Behavior Scales-II (VABS-II), and Mullen Scales of Early Learning (MSEL) and a developmental history.  Children were classified as having ROM if parents reported ≥ 3 ear infections OR if children received myringotomy tubes.

Results:   Fifty-six (20%) children were determined to have ROM. A chi-square test of independence was performed to examine the relationship between child diagnosis following a developmental evaluation and history of ROM.  The results indicated no differences in rates of ROM among children with ASD, language delays and typical development, X² (2, N = 197) = .35, Cramer’s V =.02, p = .84.  Independent samples t-tests were performed to compare the expressive language development of children with ASD with and without a history of otitis media.  The results indicated no significant differences on either the MSEL Expressive Language subscale or the VABS Expressive Communication subdomain, t = -.52, eta² = .002, p > .05.  Higher socio-economic status (SES) was associated with presence of ROM, r = .27, p < .01.

Conclusions:   Our sample did not show significant differences in the rate of ROM by diagnosis. Additionally, our finding that ROM did not relate to language differs from the current literature on typically developing children.  It suggests that the influence of otitis media on language development may be reduced in children with ASD, perhaps due to the relatively larger contribution of social development.  Our findings could also indicate the close monitoring of middle ear health leading to prompt treatments for infections may reduce the overall impact of ROM.  This monitoring may relate to access to healthcare and information, which is affected by SES.  Limitations of this study include the parent report of ROM design rather than standardized monitoring in a healthcare setting, which introduces the possible confound of parent ability to detect otitis media.