Hearing Loss and Autism diagnosis and intervention
Outline 1. Definitions 2. Prevalence 3. Diagnosis 4. Ideas for Intervention
Definitions
Definitions Autism A group of complex disorders of brain development (autismspeaks.org) DSM-V Autism Spectrum Disorder Social (Pragmatic) Communication Disorder
Definitions Autistic Spectrum Disorder -diagnostic criteria Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition: DSM-5 the standard classification of mental health disorders used by professionals globally.
Prevalence
Prevalence Autism Spectrum Disorder (Centers for Disease Control and Prevention, 2014) Prevalence of autism in the United States 1 in 68 children 1 in 42 boys 1 in 189 girls Less than half those children had received comprehensive developmental evaluations by age 3
Prevalence Comorbidity Comorbidity rates of hearing loss in children with ASD are high and increasing (Szymanski et al., 2012) Estimates of comorbidity vary (Gallaudet Research Institute, 2009) 5-6 percent of children who are deaf also have a diagnosis of ASD Possibly higher amongst the profoundly deaf estimated as high as 35.4%
Diagnosis
Diagnosis Difficulties in diagnosis Diagnostic overshadowing Differential diagnosis
Diagnosis Diagnostic Overshadowing The presumption that symptoms are a result of a current diagnosis Parents and professionals focus on the current diagnosis and the necessary treatment More prevalent as children are implanted earlier-before the chance to diagnose ASD
Diagnosis Differential Diagnosis The process of differentiating between two or more conditions Communication impairments are significant feature of both diagnoses Delay in development of Theory of Mind is a feature of both diagnoses
Diagnosis Differential diagnosis Hearing Loss Autism Spectrum Disorder
Diagnosis Differential diagnosis Hearing Loss Autism Spectrum Disorder Other diagnoses
Diagnosis Differential diagnosis Hearing Loss Autism Spectrum Disorder Late Implantation Other diagnoses
Diagnosis Differential Diagnosis 1. Persistent deficits in social communication and social interaction across multiple contexts
Diagnosis Differential diagnosis Deficits in social-emotional reciprocity HEARING LOSS Difficulty with social interaction, particularly with hearing peers Difficulty approaching or participating in conversation Desire to communicate AUTISM SPECIFIC Not responding when tapped/waved at to get attention. Not sharing emotions and/or affect. Not sharing interests (minimal giving, sharing, pointing)
Diagnosis Differential diagnosis Deficits in non-verbal, social communicative behaviours HEARING LOSS AUTISM SPECIFIC Limited expressive language can lead to unusual non-verbal behaviours e.g. pantomiming Flat affect Absent, limited or inconsistent use of nonverbal communication Hand-as-tool gesture
Diagnosis Differential diagnosis Deficits in developing, maintaining and understanding relationships HEARING LOSS AUTISM SPECIFIC Reduced development of Theory of Mind Inability to converse leads to difficulties keeping friendships May be stuck in parallel play Long standing and continuing lack of interest in peers Limited functional or imaginative play
Diagnosis Differential diagnosis 2. Restricted, repetitive patterns of behavior, interests or activities
Diagnosis Differential diagnosis Stereotyped or repetitive motor movements, use of objects, or speech HEARING LOSS AUTISM SPECIFIC Repetition of language typically based around limited understanding Unusual verbal rituals sometime with little or no meaning Fixation on limited variety of objects or toys Self stimulation/repetitive motor movements such as hand flapping, rocking, finger flicking, toe-walking
Diagnosis Differential diagnosis Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior HEARING LOSS AUTISM SPECIFIC Prefer predictability and routine Difficulties in dealing with change Significant difficulty with change in routine, lack of resolution Insistence on non-functional ritualized routines and play Upset resolves with understanding
Diagnosis Differential diagnosis Highly restricted, fixated interests that are abnormal in intensity or focus HEARING LOSS AUTISM SPECIFIC Have specific interests which often change over time Specific interest may be related to language understanding Long standing fixated interests which are all consuming Interest may be in something unusual e.g. brands of cars Carries preferred objects for no real purpose e.g. pencils, stones
Ideas for Intervention Differential diagnosis Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment HEARING LOSS AUTISM SPECIFIC Unusual or aversive responses, particularly to auditory or vestibular input Typical responses to other stimuli Unusual or aversive responses to many types of sensory input e.g. food Sensory seeking behaviours which are unusual e.g. finger flicking, eye movement Limited response to appropriate amplification
Intervention
Ideas for Intervention Assessment Consideration of hearing age Cognitive skills and behaviour patterns often mirror hearing age more closely than chronological age Look for autism specific behaviours as described
Ideas for Intervention Assessment Lack of appropriate tools and norms for children with hearing loss Assessment tools should be used with caution
Ideas for Intervention Assessment Consider M-CHAT-R
Ideas for Intervention Intervention Ideas Start as soon as possible Having the difficult talk with families Be sensitive and careful, particularly with terminology Pick a behaviour that you have observed to begin the conversation Provide resources Maintain contact
Ideas for Intervention Intervention Ideas Every child is unique Unique combination of how each diagnosis is expressed Hearing loss Severity of ASD Other comorbid diagnoses
Ideas for Intervention Intervention Ideas Consider and address needs of family Additional stress of second diagnosis It hit us very hard. I felt we had just got our lives back on track and then we were hit again. It is just so unfair. Other families just have one issue, they are so lucky
Ideas for Intervention Intervention Ideas Build a Team Rehabilitation professional needs to ensure that listening is addressed Physical Therapy Listening and Spoken Language Applied Behaviour Analysis Sensory Integration Therapy Occupational Therapy
Ideas for Intervention Intervention Ideas Predictable routines in therapy Reduced visual/tactile clutter
Ideas for Intervention Intervention Ideas Managing auditory distress May need additional MAPs
Ideas for Intervention Intervention Ideas Selection of functionally useful targets Emphasis on pragmatics and social aspects of language
Ideas for Intervention Intervention Ideas Use of visual schedules Auditory input can be maximised Listening first strategy
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What is Included in Each Kit? Lesson plans for 3 levels of ability Therapist notes that identify goals and strategies Beautiful custom drawn resources designed by professionals experienced in working with children with hearing impairment Ideas of activities and strategies for Theory of Mind development
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Ideas for Intervention References Center for Disease Control. (2014). Autism Spectrum Disorder. Retrieved from http:://www.cdc.gov/ncbdd/autism/data.html Gallaudet Research Institute (2009). Regional and national summary report of data from the 2004-2005 Annual Survey of Deaf and Hard of Hearing Children and Youth. Washington, DC: Gallaudet University. Myck-Wayne, J., Robinson, S., & Henson, E. (2011). Serving and supporting young children with a dual diagnosis of hearing loss and autism: The stories of four families. American Annals of the Deaf, 156(4), 379-390. Szymanski, C.A., Brice, P.J., Lam, K.H., & Hotto, S.A. (2012). Deaf children with autism spectrum disorders. Journal of Autism and Developmental Disabilities, 42, 2027-2037. World Health Organisation. (2012). WHO global estimates on prevalence of hearing loss (Mortality and Burden of Diseases and Prevention of Blindness and Deafness, 2012)