I was so happy to be home, not only because the storm was over and our house was safe again, but because it was private and quiet. Owen, who was two at the time, was running around in a diaper. “Owen, come here and let mommy put your clothes on you”, I instructed.
Owen’s reply: “What you said mommy?” I repeated the command to which he responded again, “What you said?” I immediately thought something was wrong with his ears. Then it dawned on me, Owen had spent the past three days with two adults who both responded, more often than not, “What did you say?” to all inquiries.
We had been staying at my in-laws house during a hurricane. Our little gathering included our family of five, my mother in law, my father in law who was hard of hearing in one ear, and my grandmother in law who was also hard of hearing. The tv was always blaring, even with the close captions on, the entire time we were there.
Little Owen was just using a new phrase he picked up. For a parent, figuring out what your child may be struggling with can be puzzling. Autism and hearing loss often go together. It can be difficult to ascertain if your child’s hearing loss has to do with the actual inability to hear, or if it is auditory processing, or if their autism spectrum disorder is at fault for their response, or lack thereof.
In this article I would like to discuss hearing loss, its link to autism, and how we can help our child through whatever challenges they face because of it.
Hearing loss and autism spectrum disorders, are they linked?
Some studies suggest hearing loss and autism are linked. According to an article in the Journal of Autism and Developmental Disorders, Vol. 29: “Profound hearing loss is uncommon among children with autistic disorder. However, the prevalence (3.5%) is at least 10 times that reported in epidemiological studies of children from the general population.”
Further study is needed though to determine the exact links. For now, we do know the effects of hearing loss and, added to an autism spectrum disorder (ASD) diagnosis, it becomes another item on the list of possible autism comorbid conditions.
Is hearing loss more common in people with autism?
According to a study titled Audiometric profiles in Autism Spectrum Disorders: Does subclinical hearing loss impact communication?: “Hearing impairment is more prevalent in individuals with Autism Spectrum Disorders (ASD) than the general population, and although ASD is not caused by hearing impairment, symptoms may be made worse by difficulty hearing.
Since there is a common occurrence of hearing loss in children with autism spectrum disorder, it is important to examine the way hearing loss and autism interact. I would also like to explore other conditions that may cause parents and health professionals to think hearing loss may be the problem when it isn’t.
How does autism affect listening?
A person with autism may have trouble giving eye contact. This can make others doubt their ability to hear. Verbal communication difficulties can also lead to symptoms that can cause hearing loss concerns. Difficulties such as:
- not responding verbally to instructions given in another room, or on the phone
- words sounding differently when spoken
- lack of spoken language indicating they did in fact hear the other person
- facial expressions that are “blank” instead of responsive
If a person does not have a hearing deficit, or if they have moderate hearing loss, in combination with autism and/or other conditions such as ADHD it can be a bit confusing for everyone.
Auditory processing disorder
Auditory processing disorder (APD) in hearing children with autism spectrum disorder could make caregivers suspect hearing loss. APD is not hearing loss, it is actually how your brain processes the sounds that you hear. It can lead to misunderstandings, and can make it difficult to participate in conversations, listen to music, or even concentrate on what someone is saying when there are other sounds happening at the same time.
This can lead to responses that make it seem like the person can’t actually hear, when their ears work just fine. A simple hearing test can determine whether or not someone is experiencing true hearing loss, or APD.
Hearing loss and autism, a dual diagnosis
Diagnosing deafness in autistic people can come about during an autism evaluation. During the autism diagnostic observation schedule, a series of activities and tests occur. The way a child responds tell the professionals working with them a lot. If hearing loss is suspected in conjunction with a possible autism diagnosis, a hearing test will be added to the list of tests needed.
In the same article from Journal of Autism and Developmental Disorders, we learn: “There are some important problems associated with the evaluation of hearing in individuals with autism, given that they are often notoriously difficult to test. There is a risk for overestimating the prevalence of hearing loss because of difficulties to obtain pure tone threshold at normal levels. By the same token, mild hearing loss can easily remain undetected.”
Someone with moderate hearing loss may present with symptoms that could mean they need a hearing aid, or it could mean they need further tests to determine if their hearing loss is due to a problem with hearing, a problem with processing, if their response is due to ASD, or all of the above. This can be quite confusing.
This is why it is important to get your child evaluated as soon as possible if hearing concerns or ASD related symptoms come up. Research, tests, solutions, and provisions have come a long way. There is still a long way to go.
If your deaf child is diagnosed with ASD, chances are you will have some questions, concerns, and research to do. The reality is, you have probably already learned more about ways to communicate with your child and understand them, than parents whose children have ASD by itself. For example, you probably already know about things like sign language, alternative communication devices, school accommodations, IEP’s and so much more!
Support
Deaf children with autism will need support for each diagnosis, as well as accommodations relating to how the two conditions affect or exacerbate each other. This is true of any comorbid condition. So what can we do?
How to help your autistic child who is hard of hearing
Many children with hearing loss benefit from therapies and techniques that also are helpful to deaf children. The good news is that if your autistic child is deaf some of the solutions to their needs will intersect. Here are some things that will be helpful for children with a dual diagnosis of hearing loss and autism.
- Picture exchange
- American sign language
- sign language interpreter
- speech language pathologist
- hearing aids
- occupational therapy
Communication challenges
Some children will have difficulty with social interaction, language development, and communication abilities. This can make school and other situations a bit harder than they would be if someone was struggling with deafness, or ASD alone.
Studies suggest that children who are autistic often fail to respond to certain things or respond in ways that can make others question their ability to hear. One study, called Speech Processing in Autism Spectrum Disorder: An Integrative Review of Auditory Neurophysiology Findings concluded: “The observed differences in neural responses to speech stimuli suggest that communication difficulties in autistic individuals are more consistent with the reduced social interest than the auditory dysfunction explanation.”
On the other hand, if loss of hearing is part of the equation, things like hearing aids could alleviate some of the symptoms that were previously thought to be attributed to ASD.
Intensifying the senses
Sensory input issues can manifest differently when someone is deaf and autistic. Certain noises, textures, tastes, and visual cues could be experienced in a more intense way.
However, hearing loss can strengthen other senses that could help someone with autism with communications. For example, deaf children often receive their diagnosis of hearing loss before their diagnosis of autism.
Their prior knowledge of sign language, lip reading, and sensitivity to facial expression could be stronger than other children with an ASD diagnosis alone. In this way, their hearing deficit becomes an asset.
Intervention
Once again we see how early intervention can really go a long way to gaining support for children with special needs. Clinical expertise is needed to determine the type of hearing problems children may have, as well as how to help with delayed speech, communication skills, and any other comorbid conditions may be present.
Summing up
Deafness or being hard of hearing and ASD are conditions found together often. There are tests to diagnose, treatments, and therapies to help families navigate their children’s needs.
Communication is key
Whether your child needs a hearing aid, has sensory processing issues, autism, or all of the above, you, and they, are not alone. Reach out to the deaf community, autism community, health professionals, friends and family. Finding others who can support, validate, love, and celebrate you and your child is so helpful.
Connection is world-changing
Parents should note that no matter the challenge, kids who receive support and love will find their way. These children have the tendency to help others be aware of things they wouldn’t be; they see things through different eyes and have a viewpoint on life that is beautiful and world changing.
Celebration is crucial
Sometimes as parents of out of the box children, we get hung up on the challenges. Those glimpses of greatness we see in our children are to be celebrated and savored.
References
Key, A. P., & D’Ambrose Slaboch, K. (2021). Speech Processing in Autism Spectrum Disorder: An Integrative Review of Auditory Neurophysiology Findings. Journal of speech, language, and hearing research : JSLHR, 64(11), 4192–4212. https://doi.org/10.1044/2021_JSLHR-20-00738
Key, A. P., & D’Ambrose Slaboch, K. (2021). Speech Processing in Autism Spectrum Disorder: An Integrative Review of Auditory Neurophysiology Findings. Journal of speech, language, and hearing research : JSLHR, 64(11), 4192–4212. https://doi.org/10.1044/2021_JSLHR-20-00738
Ahlsen, G,Gillberg, C, Nordin, V,Rosenhall, U,Sandstrom, M(No. 5, 1999)Autism and Hearing Loss. Journal of Autism and Developmental Disorders, Vol. 29, http://kejuelmi.pbworks.com/f/hearing%20loss.pdf
