KidsAudiologist

Autism Spectrum Disorder & Deafness

Posted on: October 28, 2011

Recently a mum left me a question on the NetBuddy forum about whether it was worthwhile following up a hearing loss that had been diagnosed 3 years earlier. Her 6 year old son had been diagnosed with autism at 3 1/2. At around the same time he had ABR testing that had shown a bilateral mild hearing loss. “However once the audiologist heard he had autism, he decided against hearing aids and since then no-one has really paid any attention to this.” Mum described his main problems in understanding and expressing himself with language, and he doesn’t always pronounce things correctly.

I am wary of making generalisations about groups of children and particulary so about children on the autistic spectrum who have such a diverse range of needs and abilities. It is true that some children with autism will not tolerate hearing aids. This can be physical and they are often the same kids that refuse to wear hats or headphones. There are also some who are very oversensitive to everyday sound (hyperacusis). But this isn’t the case for all ASD children so I do think there is nothing to lose in trying, especially when language development is a key issue for a child. Hearing aids can be programmed very conservatively to ensure they remain within the child’s comfort levels for sound. Hearing testing isn’t always easy as many do rely on play and cooperation with the child but there are a number of different tests that can be tried or adapted and we often have to do several types and build up a picture of the child’s overall hearing like a jigsaw. When a local audiologist doesn’t have alot of experience working with children with autism then it is worth asking the GP to refer to another hospital (perhaps a large specialist children’s hospital where they are likely to have more experience with children with complex needs).

ASD is thought to affect 1% of all children but as many as 5% of deaf children. Since newborn hearing screening was completely rolled-out across the UK in 2006 any deafness is usually diagnosed and intervention begun before autism becomes apparent. The cause of the deafness is as varied as the rest of the deaf population – including prematurity, CMV infection, genetics etc. It’s good to see that training is available such as The Ear Foundation’s Autistic Spectrum Disorder & Deaf Children course because audiologists and other professionals working with deaf children will be much more likely to have a child with ASD in their caseload than in the past when the autism was diagnosed first.

Some useful resources in the meantime:

Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders (National clinical guideline, SIGN & NHS QIS, 2007)

Recognising ADHD, Autism and deafness in the classroom (BATOD, 2010)

Assessing Diverse Students With Autism Spectrum Disorders (ASHA, 2011)

Social Communication Strategies for Adolescents With Autism (ASHA, 2011)

Managing Sound Sensitivity in Individuals With ASDs (ASHA, 2011)

Putting Research into Practice for Autism Spectrum Disorder (The Hearing Journal, 2015)

UCL run an annual Advanced Audiology Masterclass in Tinnitus and Hyperacusis. The 3 day Masterclass starts with a research update on the current understanding of the mechanisms of tinnitus and hyperacusis. It then addresses the different approaches for the assessment and management of these symptoms in adults, before focusing on paediatric patient management. In 2010 the lectures were recorded and can be watched free here including a presentation of a case study ‘The Autistic child with hyperacusis’

Oh, and my answer to mum’s was “this something we should keep pursuing?” – yes definitely! A mild hearing loss (21-40dB) is much like wearing earplugs all day. Children will often hear one-to-one conversation in quiet surroundings but struggle in noisy situations like classrooms. Because they can’t hear quieter speech they also miss overhearing a lot of information. Children need to be able to hear conversations going on all around them, even though they aren’t paying attention to it or when it may be about things that don’t seem important for young children to hear. This ‘overhearing’ is important for building vocabulary, gives children grammar, and general knowledge. There is lots of research now that shows that children with mild hearing loss are at risk of delays in speech and language development. Even if the hearing loss itself isn’t the main cause, when children have other learning or development problems then it is more likely to have an impact.

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4 Responses to "Autism Spectrum Disorder & Deafness"

Another really interesting blog, thanks. I found the link to managing sound sensitivity particularly useful.

What a great blog and great advise for families.
Thanks Vicky

s (Audiovestibular Physician & Paediatrician)

Hello, this was my query I posted. I was googling hearing tests and autism and found your blog! I really appreciated your reply and have kept badgering away. We have had two ‘failed’ audiology appointments as they have been trying to insert earphones which my son can’t bear. It’s not even on his statement about his mild loss. I’m on the case, but with such limited children’s services, my son is at the bottom of the list. He’s nearly 8 now ….

Hi Liz

Thanks for posting here. Sorry to hear that you’re still having a frustrating time getting your son’s hearing difficulties recognised and supported. Even without a complete diagnosis or hearing aids, there are lots of things that can be done to help and ensure your son is able to make the most of the hearing he has. If you’d like any help please do call the NDCS Helpline on 0808 800 8880. They can put you in touch with your local NDCS Family Officer who are experienced in negotiating local audiology and hearing support services in your area, and can offer further support with getting needs recognised through statements or discussion with schools etc.

All the best

Vicki

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