Children with autism spectrum disorders and those with deafness share the difficulty of acquiring and using language and basic communication skills. When a child who is deaf also has autism, learning and communication become even more difficult than for a child with deafness alone. Early intervention and improved strategies for teaching these children lead to better outcomes.
Challenges of the Dual Diagnosis
The ability to acquire language and learn to communicate early are key factors in a child's normal development. When a child has the dual diagnosis, the communication and social impairments of ASD can limit the ability to learn and use speech, but particularly sign language. This is especially true for those with profound to severe hearing loss and will impede other areas of learning and development.
Difficulties with learning sentence structure, vocabulary speech and writing that are common with deafness, as reviewed by the American Speech-Language-Hearing Association, may be amplified by the impairments of ASD. The severity of the autism symptoms will determine the effect on learning.
Difficulties with learning sign language are explored in a 2013 review by researchers at Boston University (BU). A summary of their research and those of others in the field include the following challenges for acquiring language and communication skills for deaf children with autism:
- Difficulties with eye contact and following or repeating the gestures of others
- Problems paying attention and comprehending facial expressions of others
- Problems with perceiving and integrating hand gestures and other visual cues
- Repetitive and stereotyped or fixated sounds and behaviors that may interfere with attention
- Difficulty sustaining a conversation and following directions
- Aversion to social interaction that interferes with interactions with instructors
- Problems with communicating needs and emotions which can lead to frustrations with learning.
For example, a study by the BU group published in the Journal of Communications Disorders in 2012 found that children with deafness combined with autism spectrum disorders had difficulty with perception and imitation of palm gestures during sign language instruction. These errors were also made by children with ASD without deafness, but not by deaf children without ASD.
Interventions and Improvements
The group in Cincinnati and the BU group and other studies on the dual diagnosis suggest strategies to improve language and communications in a child with deafness and ASD should include:
- Improving and validating screening and diagnostic tools to better identify ASD in children with hearing loss
- Increased awareness of doctors and other healthcare professionals of the signs and symptoms of ASD in hearing impaired children
- Earlier diagnosis of ASD in deaf children using these improved tools
- Early interventions in learning language and communication skills and improve social skills
- Provide better services for educating children with deafness who are also diagnosed with ASD
- Combining the best strategies for learning from the educators of ASD children and those of deaf children
- Using multiple learning tools that meet the individual learning needs and style of each child
- Improvements in educating parents/families on the impact of ASD with deafness on communication development
- Team approach to interventions to include parents/family, medical/therapeutic professionals and educational experts
- Joint agreements and close communication between members of the team
- Coordinate support services for the parents and families of these children
- More studies to understand the needs of these children to improve education and support strategies
The Cincinnati group published data in the Journal of Deaf Studies and Deaf Education in 2014 from a small parent focus group. The findings emphasize the importance of attending to the specific needs of each child and his family and the of parent input into intervention strategies.
Children with deafness combined with autism spectrum disorders have an increased challenge of optimizing language and communication because of the impairments that are common in children with ASD. New research in this group of children and in autism in general is leading to better understanding of the complexities of their learning challenges.
The goals to improve diagnosis, early interventions and other strategies are to ensure that children with deafness combined with autism spectrum disorders reach their maximum learning, language, communication and social potential.