Reliability of the Functional Auditory Performance Indicators (FAPI) to monitor progress in five-year-old children with Autism Spectrum Disorder

Abstract

Background: Atypical processing of auditory information in children with autism spectrum disorder (ASD) can be observed at a neurological as well as at a behavioural level. The Functional Auditory Performance Indicators (FÁPI) is an observational monitoring tool for pre-school children with hearing loss, but has not yet been described in children with ASD. A reliable instrument to monitor progress of functional auditory performance in young children with ASD may contribute to evidence-based practice during intervention. Method: The aim was to describe the overall performance of five-year-old children with ASD on the FÁPI; to determine the test-retest reliability and inter-rater reliability of the tool. The study was exploratory with a descriptive design incorporating repeated measures. Twelve participants with ASD were purposely selected. The mean age was 65 months and all were exposed to English as additional language. Ten of the 12 participants had very little speech as reported by their parents. Pre-recorded sound and speech stimuli were used to elicit responses from participants in their familiar therapy rooms. For test-retest reliability three data collection sessions per participant were conducted over a two-week period. Video recordings were provided in randomised order and analysed by two independent raters. The raters were blind to the order of data sets. Results and conclusion: With an increase in complexity of auditory stimuli a marked decrease in response was observed in the participants. Category seven, the highest level of auditory responses, demonstrating the child's ability to process linguistic information, showed the least responses The test-retest reliability was good, with a single difference in the category 'Awareness and meaning of sound'. Inter-rater reliability indicated a significant difference in two of the seven categories of the FÁPI, 'Awareness and meaning of sound' and 'Sound localisation' with p-values of 0,006 and 0,003. These categories may be the most subjective in the tool. Despite some subjectivity in two of the seven categories the FÁPI was reliable to plot functional auditory performance in the sample group. Since the instrument relies on direct observation with very few demands to participate on a social level, it has potential for use in five-year-old children with ASD. Further research is required to determine the tool's performance using natural sound conditions to monitor the progress of children with ASD longitudinally, against themselves during intervention.