This introduction to autism spectrum disorders (ASDs) and hearing impairments (HI) tells you how to get a diagnosis if you suspect your child has a hearing impairment.

It will be helpful to parents of children who are already diagnosed with an ASD and HI, or parents who think that their child may have both conditions. If you have concerns about ASDs, our Autism Helpline can give you more information, including advice on diagnosis. You can also read our information sheet Diagnosis: what to expect.

Getting a diagnosis of a hearing impairment (HI)

Some children with ASDs have sensory processing difficulties. If you think your child is sensitive to noise, you should take them for a hearing test.

In the UK, the NHS screens every newborn baby for hearing impairment within the first two days of its life. Newborn hearing screening (also known as universal neonatal hearing screening) provides the opportunity for children with hearing impairment to be diagnosed as early as possible, increasing their chances of good communication and language development. The test involves inserting a tiny probe into the child's ear. The probe emits small sounds and checks for a response from the child's cochlea. The cochlea is part of the inner ear. If the cochlea does not respond to the probe, further tests are carried out to determine why.  You can read more about this process at www.nhs.uk/Conditions/Hearing-impairment/Pages/Diagnosis.aspx

Your first step in getting a diagnosis of HI is to make an appointment to see your GP. They will be able to refer your child to an audiologist, who can perform a full hearing test and will be able to tell you whether your child has a hearing impairment. The audiologist can also advise on what to do next.

When you take your child for a hearing test, you will probably need to prepare them beforehand. It could be helpful to talk to the audiologist first to find out how they perform the hearing test, and to give them some information about ASDs. Our Autism Helpline can advise you on preparing your child for a visit to the doctor, or you can read our information sheet ‘Doctor: preparing for a visit’.
 
For more information about what to do if you think your child may have a hearing impairment, read the Action on Hearing Loss leaflet 'Is your hearing going?' at: www.actiononhearingloss.org.uk/supporting-you/factsheets-and-leaflets/ears-and-ear-problems.aspx. Further contact details for Action on Hearing Loss are listed at the end of this information sheet.

There are currently very few services in the UK which are experienced in diagnosing both ASD and HI, but our Autism Helpline can tell you about the services that do exist. You could also ask your doctor if there is a specialist with experience of both conditions in your area.

Research

Research into ASDs and hearing impairment is a very specialised area, so not many studies have been carried out to date. The research we do have tells us:

  • there are an estimated 9 million people in the UK who are deaf or hard of hearing – that is 1 in every 7 or 8 people. There are no official figures. (The Royal National Institute for Deaf People 2009).
  • HI tends to be diagnosed a couple of years earlier than autism. (Jure, Rapin and Tuchman, 1991).
  • according to a study of children with pervasive developmental disorders, 9 out of 35 children (25%), had hearing loss (Psillas and Daniilidis, 2003)  
  • in a study of 500 children with autism, 15% of the children aged between11 and 13 years old presented with auditory disorders (Gayda and Saleh, 2004).

If you are interested in reading these studies, visit Autism Data at www.autism.org.uk/autismdata - our online database of autism research.

Communicating with children with ASD and HI

Action on Hearing Loss suggests the following tips in order to communicate effectively with a person with hearing impairment. 

  • Make sure you have the listener's attention before you start speaking.
  • Speak clearly but not too slowly, and don't exaggerate your lip movements. 
  • Use natural facial expressions and gestures. 
  • Don't shout. 
  • If the person doesn't understand what you've said, don't just keep repeating it. Try saying it in a different way. This may not be helpful for all people with autism due to problems with processing verbal information. Try backing up what you’re saying with visual supports. 
  • Use plain language and avoid jargon.
    People in the UK who have HI use various methods of communication. 
  • British Sign Language (BSL) is the most widely used method of signed communication.
  • Sign Supported English (SSE) is used by some people. SSE is not a language in its own right, but provides a visual support when using English.
  • Sign language of any kind can be difficult for a person with an ASD to use. It relies on facial expression, gestures and body language, all of which may not be readily understood by someone with an ASD.

Strategies for dealing with ASD and HI

Professionals who specialise in ASD and HI do not always agree on the best approaches for children with both conditions. But many professionals have found that when parents teach their child sign language at an early stage, it can help them to communicate and assist their learning as they grow up. Here are some approaches you could try.

Visual supports

Many people with an ASD are thought to be visual learners. So by presenting information visually you may be able to encourage communication and support the language development. Visual supports provide an uncomplicated method of communication that anyone with an ASD could potentially benefit from, regardless of their age or ability. Whichever visuals you use, they should be appropriate to you child’s individual needs and their current stage of development. There are more details in our information sheet on visual supports.

Objects of reference

People with HI and people with an ASD both sometimes use ‘objects of reference’ as a means of communication. This method uses physical objects to communicate something that is going to happen or to prepare for a new situation - for example, a shampoo bottle to represent bath time. Objects of reference are particularly useful for people who struggle to make the link between a visual symbol and the object it represents. They can also be used to help a person make choices and decisions, or alongside visual timetables. 

British Sign Language (BSL)

BSL uses  hand shapes and movements, facial expression, and shoulder movement. People who use BSL also use finger spelling, which is not a sign language in itself but allows you to spell out certain words - usually the names of people and places - on your fingers, BSL is the sign language used on television, but it’s important to remember that the language is only used in the UK. Sign languages are as different as spoken languages, so, although some may have a similar structure, deaf people in different countries will communicate with different sign languages. Likewise, BSL has regional variations just as spoken languages have different dialects. Action on Hearing Loss has a range of resources to help you use BSL.

Makaton

Makaton is a communication system that uses symbols to represent key words. It consists of a core vocabulary which can be developed into sentences and is designed to be used alongside speech where possible. Makaton is used by and with people who have communication, language or learning difficulties, including people with autism. It helps the development of speech and language in children, and acts as a means of functional everyday communication for adults. It has also proved useful for toddlers, who can learn to use the symbols before they have mastered speech. For more information about Makaton, go to www.makaton.org

For each of the approaches outlined above, it is important that everyone involved in your child’s life, including you, your relatives, the child’s school and the other professionals they come into contact with, use the same communication system. Speak to a psychologist, psychiatrist or educational psychologist to discuss the best approach for your child. It may take time for your child to get used to the approach you choose and learn how to use it in real life, but you should continually monitor and evaluate its effectiveness. 

Online support

There are a small number of online support groups for parents of children with ASD and HI:

Joyce Fisher (mother of two boys with ASDs and HI)
www.geocities.com/Heartland/Ridge/9672/index.html

David and Heidi Good (USA)
www.deafautism.com

Rosangela George
www.deafautism.com/autreat2008.html

Yahoo online group
http://health.groups.yahoo.com/group/deaf-autism-group/

Odyssey magazine
This magazine has an issue which focuses on autism and deafness. Use the link below to download the issue:
http://clerccenter.gallaudet.edu/Clerc_Center/Information_and_Resources/Publications_and_Products/Odyssey/Vol_9_Issue_1.html

References and bibliography

Gayda, M. and Saleh, D. (2004). [Peripheral, central and psychic deafness: diagnosis difficulties in case of autism child ] Revue de  Laryngologie – Otologie-Rhinolologie (Bord), Vol. 125(5), pp. 277-280. [Article in French]

Happe, F. (1994). Autism: An introduction to psychological theory. London: UCL Press

Jure, R., Rapin, I. and Tuchman, R. F. (1991). Hearing impaired autistic children. Developmental Medicine and Child Neurology, 33(12), pp1062-1072

Psillas, G. and Daniilidis, J. (2003). Low-frequency hearing assessment by middle latency responses in children with pervasive developmental disorder. International Journal of Pediatric Otorhinolaryngology. Vol. 67(6), pp613-619

Contacts and resources

Contact a Family
Contact a Family provides advice, information and support to the parents of all children with a disability around the country for parents of children with disabilities.
Website: www.cafamily.org.uk
Tel: 020 7608 8700

Autism Services Directory
You can find details of face-to-face support groups and other services in your area on The National Autistic Society’s Autism Services Directory.
Website: www.autismdirectory.org.uk

The Makaton Vocabulary Development Project
Tel: 01276 606760
Email: mvdp@makaton.org 
Website: www.makaton.org 

Action on Hearing Loss
Freephone Information Line: 0808 808 0123
Textphone: 0808 808 9000
Email: informationline@hearingloss.org.uk
Website: www.actiononhearingloss.org.uk

The National Autistic Society
Our own website is probably the world’s largest online autism resource.
Autism Helpline: 0808 800 4104
Website: www.autism.org.uk


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