Specialist audiology clinic for children with complex needs

The Hummingbird Clinic is a hearing assessment service at St Thomas’ specially designed for children with conditions such as autism or cerebral palsy who cannot be tested with the usual methods.

It is the only service of its kind in London and was made possible thanks to generous donations.

A unique service in London

The clinic was set up by staff as part of the new Children and Young People’s Audiology Centre and is a unique service for youngsters with complex conditions, particularly autism. ‘We know that children with autism and complex needs require an individualised approach to their appointments,’ says Naomi Austin, clinical lead at the Children and Young People's Audiology Centre. ‘So we created this clinic, which uses specialist equipment and a more flexible clinical approach.’ It is estimated that more than one in every 100 children is on the autism spectrum and the number of children diagnosed with autism in Southwark schools has increased by 80% in the last five years. ‘It’s so difficult to cater for all of the needs of all of the children, but because we get such a high volume of autistic children – because they’re often non-verbal – it’s something really worth working on.’

A specially designed environment

For autistic children, it is very important to have a routine and predictability, so the prospect of being in a new environment – particularly somewhere as frightening as a hospital – can be very distressing. This distress is exacerbated by bright lights, colours and loud noises. The team looked at autistic schools and sought advice from the National Autistic Society when designing the centre. The waiting room has a relaxing environment inspired by a Japanese garden, with bamboo walls, comfortable furniture and no noisy equipment or overly bright colours. Continuity is important for autistic children, so colour-coded stepping stones in the corridor ensure the transition from the waiting room to the test suite is anxiety free. The clinic also uses a visual timetable to allow children with autism to predict and understand what will be happening to them during their visit and in what sequence. Parents and carers are contacted before their appointment to discuss how to tailor the visit to their child’s individual needs, so that the children come to the clinic in the best frame of mind. ‘We ask if there are any negative triggers for the child to ensure they feel as comfortable as possible during their visit to the audiology clinic. The parent is also sent a ‘Social Story’ to read with the child before their visit, again to reduce any potential anxiety.’ A Social Story is a short description of a particular situation, event or activity which includes specific information about what to expect in that situation and why.

A new approach to testing

The clinic uses iPads so that apps and music can be downloaded for each child. There are toys specifically for children with autism and children who are visually impaired or have limited motor control; these all help to make the children calm and relaxed during the testing session. ‘We ask parents if their child has any preferences for music and visual rewards or television shows which we can incorporate into testing,’ says Naomi. ‘This increases the likelihood of getting good results and keeping the child’s interest during the session.’ Sessions with children who respond to sound in a non-standard way are recorded so that they can be used to train staff and review the way audio tests are undertaken, and parents are involved in the interpretation of their child’s responses. This includes children with conditions like cerebral palsy, who may not be able to turn when they hear a sound. Their responses – such as eye-widening, changes in breathing or pulling a face – need to be carefully analysed to ensure the most accurate results.

Seeing the difference

The clinic launched in March this year and the team are already seeing a positive difference. A full evaluation will take place in 2015 but Naomi and her team have seen significant improvements in the behaviour of the children. ‘It really is working,’ she says. ‘The kids are much better. We have one little boy who still won’t look at you and won’t acknowledge you, but he will sit in the room and do a hearing test. Two years ago there’s no way he could have done that.’ She hopes that the evaluation will prove the number of appointments that autistic children need before diagnosis has been reduced and that the team are getting more accurate results. If so, they hope to advise other departments across the country on how to better cater to autistic children’s needs.

Donations have enabled Guy’s and St Thomas’ to develop this unique audiology clinic.

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