Identifying Autism in the Deaf/Hard-of-Hearing Community

There are higher rates of autism among deaf or hard-of-hearing (D/HH) people than hearing people (1). In addition, about half of autistic people have hearing differences (1). However, it can be hard to diagnose autism in the D/HH population.

Challenges

There are two main challenges when trying to diagnose autism in the D/HH population. One is that many signs of autism look similar to signs of someone who is D/HH (2). The second reason is that there are no validated tests to diagnose autism in D/HH people (2).

Some characteristics that autistic people and D/HH people share are:

• Being less social or less oriented to people
• Few or no spoken words
• Less responsive to noise or what is around them

An individual showing the above characteristics could be autistic, D/HH, or both, or potentially another unrelated diagnosis. However, restricted interests or repetitive behaviors are often seen in people with autism and other developmental disabilities, but they are not usually seen in typically developing D/HH people (2).

It is also important to know that with appropriate services, typically developing D/HH children can develop their language skills at a similar rate to their hearing peers. There could be more language delays or differences if the child has autism or another developmental disability (2).

It is also challenging to get an autism diagnosis because there are no validated assessments for DH/H population (2). For example, the ADOS-2, typically considered the gold standard for diagnosing autism, does not include a standardized way to modify the assessment for the D/HH population that has been scientifically tested. The only way to diagnose autism for D/HH people is through interviews, observations, and ruling out other possible diagnoses.

Important Note: Not all providers will have experience with these overlapping signs and be able to provide a diagnosis. It may be important to consult various specialists or seek second opinions to identify the correct diagnosis.

Offering Support

Communication is so important for development. Regardless of whether a person is autistic or D/HH, there are some strategies that might be helpful even if you are not sure of their exact diagnosis. For example, using visuals can be very helpful. This can be done using pictures, AAC devices, apps on a smartphone, or even using paper and pencil or a whiteboard. Using pictures can help people with the most basic needs and is relatively easy to use. They are typically used in two ways to support someone who may be autistic, D/HH, or both. Pictures can be used to help a person make a choice or express their thoughts, wants, and other needs. For example, you could show a few picture choices of foods for lunch and allow the person to pick the one that they want to eat. You can also use pictures to communicate to the person what is happening next in a schedule or what is expected in a situation.

*This resource was created in collaboration with Stephanie Dille-Huggins, MA, BCBA.

Sources
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10271818/

2. A Summary of Current Understanding Regarding Children with Autism Spectrum Disorder Who Are Deaf or Hard of Hearing

Amy Szarkowski, Ph.D., Deborah Mood, Ph.D., Aaron Shield, Ph.D., Susan Wiley, M.D., and Christine Yoshinaga-Itano, Ph.D