We are pleased to welcome Gail Whitelaw, Ph.D., CCC-AUD, as our
guest host for the SLP chat tonight,  Monday, January 26th, 2004.
She will be addressing the topic of The Use of FM Technology with
ASD (Autistic Spectrum Disorders), ADD (Attention Deficit Disorders),
and APD (Auditory Processing Disorders).

Dr. Whitelaw is currently the Director of Clinical Instruction
and Research in the Department of Speech and Hearing Science at
The Ohio State University.  She is an audiologist with primary
interest in pediatrics, including educational issues in children
with hearing and listening impairments, classroom acoustics, and
amplification issues.  Dr. Whitelaw consults and provides
educational audiology services to a number of school districts
in Central Ohio. In addition, she is a frequent presenter on the
topic of Auditory Processing Disorders at State and National
meetings.  Dr. Whitelaw is currently the audiology faculty member
on a 5 year Maternal-Child Health (MCH) Grant with the focus of
leadership training in neurodevelopmental disorders at the
Nisonger Center at Ohio State.   Dr. Whitelaw serves on the Board
of Directors of the American Academy of Audiology.

<Robin> Welcome!  Tonight we are chatting with Gail Whitelaw, Ph.D., CCC-AUD about The Use of
          FM Technology with ASD (Autistic Spectrum Disorders), ADD (Attention Deficit Disorders),
          and APD (Auditory Processing Disorders).
<Robin> Dr. Whitelaw, please give us a definition and an overview of FM technology.
<GailWhitelaw> Sure!  FM technology is generally considered to be that which enhances the
          signal-to-noise ratio of the listening environment.
<GailWhitelaw> It can be a personal system--ear level or body worn or soundfield
<Robin> Can you explain about how the soundfield works?
<GailWhitelaw> The soundfield FM system is similar to a personal system--it has a transmitter
          (worn by the teacher) and a receiver--usually speakers in the classroom or a desktop
<GailWhitelaw> It provides the "most bang for the buck" and covers the largest area for the
          largest number of students.
<AdrienneFSU> Can it be transported with the student?...like for high schoolers changing classes?
<Anna> good question
<GailWhitelaw> A desktop soundfield can--they're great for that.
<GailWhitelaw> A number of manufacturers make these and they are portable...like insulated
<AdrienneFSU> Would you recommend this for every classroom?  Or just those with students who
          have these disabilities?
<GailWhitelaw> It depends.   All children, by virtue of childhood, benefit from improved
<GailWhitelaw> Many schools have set up FM systems for every classroom soundfield...and show
<GailWhitelaw> However, this becomes a problem when we talk about special populations for the
          reasons you all are raising.
<GailWhitelaw> Many educators and some of us (audiologists and SLPs) have overgeneralized the
          benefits of FM and treat it as a panacea for all behaviors they observe as possibly
<Anna> hmmm
<lopa0006> I definitely agree. I have a parent who wants to try an FM instead of medicine for
          highly distractible kids.
<GailWhitelaw> and it's hard, because some excellent reserach in FL by Gail Rosenberg and her
          colleagues says all kids do well with enhanced signal-to-noise ratio.
<GailWhitelaw> and the research suggests that these kids don't present with primarily
          auditory issues.
<lopa0006> What if there is more than one student in the class who needs an FM-how does that
<GailWhitelaw> There are ways to couple FM systems to each other, such as coordinating mics...
          and we are starting to see more users of personal FM systems in classrooms that are
          amplified.  One of the issues is that there aren't "universal frequencies" so this
          takes time in coordination in working with manufacturers in order to make a situation
          like this work.  It's best to try to anticipate this up front--like using one
          manufacturer as your source of equipment, however this is not always feasible
          (e.g. districts often have their own equipment that's still working well and now they
          want to change to a newer product from a different manufacturer) or possible (the
          manufacturer does not produce a product that you are in need of).  It's best to have an
          audiologist familiar with FM work with the school district and the manufacturer work on
          these issues together.
<Mike> Who sets the setting for optimal amplification?
<GailWhitelaw> Mike, this should be the role of an audiologist, however in many schools, it's
          relegated to the manufacturer's rep or the school nurse.
<GailWhitelaw> The problem is, some kids may really benefit if it's set up right, but will not
          if these issues are not taken into consideration.
<Robin> Who sets it in your school, Mike?
<Mike> In NYS (New York State) the criteria for referral is different for the SLP and the nurse,
          where are they trained?
<Mike> Our CSE chair asks the SLPs to do it, I'm not comfortable.
<GailWhitelaw> Well, part of this seems to be scope of practice issues.
<GailWhitelaw> However, when we are taking about fitting technology on normal hearing children,
          the system must be "transparent".
<GailWhitelaw> And, if someone's not comfortable fitting it--that in itself should be a criteria
          for fitting.
<Mike> agree
<Robin> What do you mean by "transparent" ?
<GailWhitelaw> Transparent means that the FM system is providing singal to noise ratio
          enhancement but no "gain" (power)...audiologists can measure this with "real ear"
          measures and probably should when we're talking about personal systems.
<GailWhitelaw> We need to educate CSE chairs, etc., that an FM isn't a solution for all kids and
           one size doesn't fit all for FM systems.
<lopa0006> In relation to scope of practice issues-I usually tell parents to investigate the
          attention route and then after that is so-called "ruled out" I may recommend auditory
          processing if the issue is primarily auditory..but it is hard to decipher!
<Robin> How can FM technology benefit the special populations of ASD, ADD and APD?
<GailWhitelaw> Well...there is clear evidence that for a clearly identified APD, an FM system
          can be of benefit.
<GailWhitelaw> For ASD and ADD/ADHD....no evidence....
<GailWhitelaw> And for ASD,  these kids often have negative effects from use of FM.
<GailWhitelaw> Unfortunately, people like to overgeneralize behavior to the auditory system--it's
          vague and more palatable than some of the other possiblities.
<AdrienneFSU> Can you use these systems on a trial basis?
<GailWhitelaw> Adrienne, most manufacturers are very anxious to get these in your hands--so they
          will set up a free 45 day trial.  In addition, our clinic has loaner equipment, as do the
          Special Education Resource Centers in Ohio.
<Robin> So what does a teacher do if there are some kids in the same classroom who could benefit
          from the system, but others wouldn't..use a personal system for those who would benefit?
<GailWhitelaw> Great question.  We assume that the only way to handle acoustical issues is by
          technology, but acoustical treatment may improve the room enough.  Research says
          preferential seating does not work, but if the room is set up well, it's easier to
          identify those high risk listeners who might benefit from a personal system.
<AdrienneFSU> Can you tell us about the set up costs? The system, the consulting Audiologist, etc?
<GailWhitelaw> Adrienne, our clinic contracts with districts (about 12) in Central Ohio--and we
          charge $65/hour for these types of consultation.
<Mike> Come to NYS, it is $135/hour.
<GailWhitelaw> The system cost varies based on manufacturer and type of system, $600-$3000.
<AdrienneFSU> Are the schools required to pay for this?
<GailWhitelaw> Adrienne, another good question.  Acoustic modifications can be on either an IEP
          or a 504 plan, so the mandate to pay probably depends on that.
<GailWhitelaw> For much FM technology, parent groups (PTO) etc. have provided this to the
<GailWhitelaw> We have philanthropic groups that also provide these to individual distircts--
          like a bakesale for good listening?
<Anna> I have a child with decreased cognitive functioning status post a brain tumor years ago
          and audiological testing found that she has CAPD, I find it hard to believe that she
          could even follow the directions during testing.  How reliable could those results be?
<Anna> Her parents are really pushing FM technology, but I'm not sure she is the right candidate.
<GailWhitelaw> Anna, many kids like this are referred to us.  Depending on the APD tests
          performed, cognitive skills can be minimized.
<GailWhitelaw> However, often these types of kids are very difficult to test.
<GailWhitelaw> And parents have high expectations of FM technology.
<Anna> I don't want them to think this will be the fix.
<GailWhitelaw> I gave a talk about adults with TBI that I have worked with that I have had
          tremendous success with a MicroEar product (ear level FM for normal hearing), but it
          takes a very careful well controlled trial.
<Anna> I'm willing to try a system with this child and another with APD & ADD.
<GailWhitelaw> I hope that an audiologist working with such a kid would give the parents
          realistic expectations, but as you guys know, many of us see ears and not kids.
<Anna> Unfortunately, I think sometimes we deal with a lot of denial re: deficits and we are
          expected to just "fix things".
<Robin> What type of acoustic modifications would you suggest for a classroom?
<GailWhitelaw> Well...acoutical wall treatments are excellent...but costly and require
          consultation.  Carpeting and soft furniture (which often are stopped due to concerns
          about asthma), covers for the feet of chairs, window coverings, etc.
<GailWhitelaw> Quiet things--no ceiling fans, no loud aquariums, etc.
<Anna> Would tennis balls on the bottom of the chairs be adequate as covers for the feet of
<GailWhitelaw> Used tennis balls work fine!
<AdrienneFSU> What about non-school settings?  home, ballet class, ...
<GailWhitelaw> Adrienne  Non-school settings are an issue, but much less of an issue due to the
          fact that acoutics in homes are generally good and other settings like dance have a
          smaller number of kids and easy visual cues.
<mary> We have FM classroom systems that really benefit all students.
<Robin> Tell us about what systems you are using Mary.
<mary> Lightspeed systems
<Robin> Mary, what types of students is this system benefitting?
<mary> Regular ed and special ed students that are mainstreamed. I'm in a middle school.
<GailWhitelaw> Mary, I agree with you on this--and good acoustics can benefit all kids
<GailWhitelaw> If you haven't read the Rosenberg study, it's amazing.  The kids that do the
          best with enhanced signal-to-noise ratio are those that are typically developing.
<Robin> Was this a large study?
<GailWhitelaw> Huge--many districts in FL over a 3 year period.
<GailWhitelaw> It was published by the Educational Audiology Association.
<Robin> With those results, schools will be pushing to have this technology in all their
<GailWhitelaw> Robin, you asked a question about benefits earlier.
<GailWhitelaw> I think it's important to verify benefit.
<GailWhitelaw> There is a questionnaire called the LIFE which was authored by Anderson and
<GailWhitelaw> I find it very useful, particularly for parents who see FM as a panacea.
<GailWhitelaw> It was also used in the Rosenberg study.
<Robin> Where can we find this LIFE questionnaire?
<GailWhitelaw> The LIFE questionnaire is available through the Educational Audiology Association.
<GailWhitelaw> However, they are modifying it and soon it will be available for free on a website
          they are developing.
<Robin> Tell us why this questionaire is so useful?
<GailWhitelaw> It allows the observer to look at specific behaviors and has a student component.
<GailWhitelaw> In the past, it was much more subjective.
<Anna> Could it be used to educate parents?
<GailWhitelaw> Yes, absolutely--it's great for identifying the types of things you might expect
          to see as a benefit and those that aren't auditory.
<GailWhitelaw> It also gives a semi-statistical way to look at change...so it's more than a
          hawthorne effect.
<Anna> great
<GailWhitelaw> Are any of you using FM with kids with autism or feeling pressured to?
<Anna> Thank goodness no.
<mary> no
<Robin> Gail, you said that using FM with kids with autism can have a negative effect, right?
<GailWhitelaw> These kids are often negatively impacted by contrast and also the tactile aspects
          of an FM.
<GailWhitelaw> So, they are more distracted by the system than it provides assistance.
<lopa0006> Yes-they are more distracted by the system.
<GailWhitelaw> Often, these are kids who are fit with something the Special Ed Director had
          lying around his/her office.
<lopa0006> My district uses personal FMs for APD and ADD but we (SLPs) are trying to work on
          funding for more of an FM soundfield in the classroom with speakers (through PTA money).
          My challenge is working with more than one personal FM in a class-how does the receiver
<GailWhitelaw> Lopa0006, what type of system are you using?
<lopa0006> It is a Phonic Ear with the teacher using a headset for the transmitter and the
          student has headphones and the receiver.
<Anna> Where could I find more info about MicroEar?  Also, are there other companies/vendors
          you recommend?
<GailWhitelaw> The MicroEar is available from Phonak...you can check their website.  They also
          have a new product called the Edulink that should be impressive.
<GailWhitelaw> The best manufacturers are the ones that work for your needs, have reliable
          products, and can give you a good price.  This can be all of them, depending on your
<lopa0006> The MicroEar sounds much better. I do find that in our district that we contract out
          Audiologists and they make the recommendation.
<Anna> Okay, starting checking them out after a colleagues recommendation.  Phonic Ear doesn't
          have anyone who can come out for at least a month as they are short staffed in my region.
<GailWhitelaw> Wo..lack of support loses sales.
<GailWhitelaw> The MicroEar is a neat product but it looks like a hearing aid, which turns some
          parents and kids off.
<GailWhitelaw> It's a small hearing aid case, though.
<GailWhitelaw> I have worked with Lightspeed (as mary mentioned) and also Audio Enhancement--
          both have good products.
<lopa0006> I have two students who have hearing aides that have the boot attached to their
          hearing aides..which works great..I think that is a Phonak product?
<GailWhitelaw> Lopa0006--that's the MicroLink and it's also by Phonak.
<Anna> I was quite surprised myself re: Phonic Ear.
<GailWhitelaw> However, Phonic Ear has a boot system now called the LEXUS--so far, it looks
          very similar to the Phonak system.
<Robin> We have been chatting for close to an hour! Are there any more questions for Dr. Whitelaw?
<Robin> Thank you, Dr. Gail Whitelaw, for joining us and sharing your expertise once again!
<GailWhitelaw> Thanks for your time!
<Robin> Thank you all for coming and sharing your experiences with FM technology.
<Anna> Thank you!
<lopa0006> Thank you- I will look into the MicroEar from Phonak!
<AdrienneFSU> thanks
<Becky> Thank you, very informative
<GailWhitelaw> Bye--thanks