Autism Spectrum Disorder in Children Who Are Deaf and Hard of Hearing. Presenters included Michael Scott, AuD and Susan Wiley MD on 2/27/14.

This presentation included several elements to be considered when a child presents with a dual diagnosis of ASD and hearing loss or deafness. Commonalities include deficits both in communication and the development of abstract language. Modern technology makes it possible to diagnosis hearing loss in infants as early as 3 months of age. As a result, early intervention is possible to support improved language outcomes. The age of diagnosis for ASD can occur at ages 3 years to 15 years. The presenters indicated there should be a push for earlier identification of children with ASD. The difficulty lies in the lack of validated tools according to Dr. Wiley. Attention is needed for key communication and deaf children have added language processing demands. With both conditions present, ASD and deafness or being hard of hearing, challenges to develop communication and social interactions increase. One important issue presented in the webinar is the opinion of Dr. Wiley that “lack of validated evaluation tools and expertise…can cause over-diagnosis and under-diagnosis of ASD.” A child who receives a hearing device will continue to have previously identified disorders, such as learning or cognitive, etc. A hearing device does not mitigate all issues. Multiple diagnoses require the multiple disciplinary teams to develop appropriate expectations.

From the audiologist’s perspective, what the child is truly capable of may not be fully realized. Challenges can include working with very involved children and providing an education to caregivers. Overwhelmed parents, difficulties testing the children (e.g. decreased developmental ability of child to perform), other medical issues, the fact that hearing loss is invisible, and delay in other diagnoses due to focus on hearing loss, are notable challenges faced by audiologists. Various tools, both formal and informal, for assessing children for hearing loss were presented. In addition to establish a comfortable environment, play, environmental changes, and parent interview were noted as useful prior to structured testing.

A focus group was organized including individuals with expertise in the fields of deaf/hearing loss education and autism spectrum, and those who have worked with children who are identified with a dual diagnosis. Findings of the focus group resulted in the unanimous agreement collaboration between medical, therapeutic, and educational settings was paramount. Functional skills were noted to be an area of priority. Parents would like more access to social groups. Limitations of extended school year programs and better training of professionals working with this population were noted considerations. Parents seemed to indicate that ESY programs were not as effective and looked different from the typical school year program.