Autism Spectrum Disordersand Deafness

Illinois State Board of Education -

Illinois Statewide Technical Assistance Center

Illinois Service Resource Center – Serving D/HH student behavioral needs

Topics

• Review ASD and hearing loss

• Shared characteristics

• Diagnosis and Intervention

• Communication/ Language Acquisition

• Socialization

• Behavior

Autistic Disorder

Rett Disorder

Childhood Disintegrative Disorder

Asperger Disorder

PDD/NOS

Autism is a syndrome which means it is a collection of symptoms

NOT a disease

Autism is a disorder,ranging from mild to severe underthe umbrella of pervasive developmental disorders

Characteristics TriadCharacteristics Triad

Com

mun

icat

ion Social Interaction

Repetitive Activities

Communication - Language Skills

Most Involved Least Involved

No language, Limited- Unusual use Advanced

no gestures echolalic of words/ vocabulary, phrases repetitive,

literal

Adapted from Wing, L. (1991). The relationship between asperger’s syndrome and Kanner’s autism in U. Frith Autism and Asperger Syndrome (pp 122-146).

Cambridge: Cambridge United Press

Communication - Social(verbal and non-verbal)

Most Involved Least Involved

No overt Communicates Replies if Spontaneous,

communication needs only approached but repetitive,

one-sided

Social Interaction

Most Involved Least Involved

Aloof and Approaches Passively Makes odd,

indifferent for physical accepts one-sided

needs only approaches approaches

Repetitive Pattern of Self-Chosen Activities

Most Involved Least Involved

Simple, Simple, Complex Verbal

bodily- object- routines, narrow interest

directed directed manipulation (calendars,

(face-tapping (taps, spins, of objects or movement of

self-injury) switches movements planets,

lights) (bedtime repetitive

rituals, questioning)

lining up

objects)

SENSORY DIFFERENCESSENSORY DIFFERENCES

Over sensitive

Under sensitive

Unusual interest

Emotional labile/unable to self-regulate

MOTOR DIFFERENCESMOTOR DIFFERENCES

Poor fine motor skills

Clumsy

Very agile

Unusually good fine motor

Strong motor memory

Splinter skills are common; Savant skills are rare

New research concludes that the percentage of individuals with mental retardation is much smaller than earlier estimated

Cognitive DifferencesCognitive Differences

Illinois Autism/PDD Training and Technical Assistance Illinois Autism/PDD Training and Technical Assistance

ProjectProject

ASSUME COMPETENCE!

Hearing Loss

• Mild• Moderate• Severe• Profound• Sensorineural• Conductive• Unilateral• Bilateral

Educational Challenges for a child with a hearing loss

• Vocabulary Development• Communication options• Development of reading skills• Behavior

– frustration

• Social

Brown’s Stages of Expressive Language

• Stage One- 15-30 months– About 50-60 word vocabulary

• Stage Two - 28-36 months– Add Present progressive verb endings (-ing)– Add usage of in and on– Begin to use plurals

• Stage Three- 36-42 months– Add irregular past tense (me fell down)– Possessives– Use of TO BE verbs

Brown’s Stages of Expressive Language

• Stage Four- 40-46 months– Add use of articles– Regular Past Tense (she jumped)– -ed endings– Third person regular tense (he swims, man brings)

• Stage Five - 42-52+ months• Third person irregular (she has, he does)• Full form of TO BE verbs ( Are they swimming)• Shortened form of TO BE verbs when only verbs in the sentence.

( She’s ready)• Auxilary form of TO BE ( They’re coming.)

Stages for Deaf Children and Children with Autism

• Children with autism MAY begin to move through the language stages and then stop upon entering Stage Two or Three

• Deaf children of hearing parents are delayed in all stages of their development. They will continue to use gestures until explicit exposure to language through either auditory or visual channels. This may not occur until a child enters school at the age of three.

Language Development

• Hearing Loss– Lack of expressive

language development– Responsive to adult

interactions– Participates in turn taking– Acquires, but has difficulty

with JOINT ATTENTION– Natural pattern of ASL

grammar and syntax even in deaf of hearing parents

– Low Base Vocabulary

• Autism– Loss of Language at

about 18-24 months– Unresponsive to adult

contact– Does not participate in

turn taking games– Lack of JOINT

ATTENTION– Echolalic– Reversal of Pronouns– Lack of Pragmatic

Autism is NOT a rare disorder

Autism is the most commonAutism is the most commondevelopmental disorderdevelopmental disorder

nd

Autism is more common than:

Down SyndromeCerebral PalsyChildhood DiabetesCystic FibrosisDeafnessPKUAll forms of childhood cancers

Source: Illinois State Board of Education IDEA Child Count Data December 1, 2006

Number of Children in Ilinois Receiving Special Education under the Category of Autism Ages 3-21

19602305

2904

3662

4330

5175

6125

7193

8293

9455

10608

0

2000

4000

6000

8000

10000

12000

1996-1997 1997-1998 1998-1999 1999-2000 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

Number of children with autism Number of children with autism in Illinois is increasingin Illinois is increasing

Number of children with autism “counted” in Illinois has more than doubled over the last five years.

Number of children with hearing loss stays steady

Variation in diagnosis/identification

Why is ASD increasing?

Greater awareness

True increase

ASD prevalence affects approximately an average of 1

child in every 150

Centers for Disease ControlCenters for Disease ControlAutism and Developmental Disabilities Autism and Developmental Disabilities

Monitoring Network (ADDMMonitoring Network (ADDM)February 2007February 2007

Annual Survey of Deaf and Hard of Annual Survey of Deaf and Hard of Hearing Children and Youth Gallaudet Hearing Children and Youth Gallaudet

Research InstituteResearch Institute2006-20072006-2007

1 in every 76 deaf children was found to be receiving services

for both a hearing loss and autism (about twice the

prevalence for hearing children)

Journal of Autism and Journal of Autism and Developmental DisordersDevelopmental Disorders

Hearing loss occurs more often in children who have autism

than in children without autism

Rosenhall et al., 1999

When are children with ASD When are children with ASD diagnosed?diagnosed?

Average age of hearing child diagnosed with autism 3.1 years old

Average age of deaf child diagnosed with autism – 4.1 years old

Mandell, Novak, Zubritsky 2005

How are children with ASD How are children with ASD diagnosed?diagnosed?

• General and Developmental Milestones

• Routine Developmental Screening at well child visits– Refer to Early Intervention– Lead screening– Formal Audiological Assessment– Autism Screening– Formal Diagnostic Evaluation

Illinois Autism/PDD Training and Technical Assistance Illinois Autism/PDD Training and Technical Assistance ProjectProject

Evaluation ToolsEvaluation Tools

Childhood Autism Rating Scale

Gillian Autism Rating Scale

Asperger Rating Scale

ADOS-Autism Diagnostic Observation Scale

How are children with ASD How are children with ASD diagnosed?diagnosed?

“Gold Standard” Autism Diagnostic Tool

*ADOS (Autism Diagnostic Observation Schedule)

*States not to be used with deaf children

How are deaf children How are deaf children diagnosed with ASD?diagnosed with ASD?

There are currently NO approved instruments for

diagnosing autism in a deaf child.

Early Diagnosis and InterventionEarly Diagnosis and InterventionVery Important!

Jacobsent, 1998/Columbia Pacific 1999

Inhibits development of inappropriate behavior

Teaches functional communication

Promotes healthy family adjustment

Early Diagnosis and InterventionEarly Diagnosis and Intervention

Children with ASD or Hearing Loss who begin intervention before the age of 3 achieve more positive outcomes than those who begin intervention after age 3.

Very Important!

Jacobsent, 1998/Columbia Pacific 1999

•Later diagnosis makes critical early intervention less achievable

• Hearing loss can mask autism Szymanski and Brice, Odyssey Magazine, 2008

Diagnosis and Intervention

Communication Issues

• Communication that is Transient– message there

then gone– easily missed

• sign• speech

• Develop communication processes that are Non-Transient– Message there long

enough to take in and process

• printed• objects

Language Development Practices that can aid both

Deaf Children and Children with Autism

• Repeat signs/speech and short sentences again and again. This gives the child several chances to notice them and recognize the language patterns. Babies seem to find repeated language interesting. Tap on objects, point, use interesting facial expressions, and use other strategies to help babies/children see and pay attention to language.

Nonverbal children can benefit:

• One strategy deaf mothers use often — waiting for a child to look up before signing to them — means that deaf mothers tend to send fewer language messages to their babies than hearing mothers do in the same amount of time. Still, the signed language skills of deaf babies with deaf signing parents develop as quickly as the spoken language of hearing children.

Sign Language Development

• Children with autism avoid eye contact• May be helpful for children with Autism due

to difficulties with cross-modality – converting auditory information to vocal utterances (Bonvillian et al., 1981) or severe auditory processing deficits (Ruttenberg & Gordon, 1967)

Communication Support

• Wait• Use visual tools

– schedules– calendars– visual directions– Children who have started in a HI program

and then placed in programs designed for children with autism move through a PEC system quickly. ?Why?

Social Differences

• Lack of interest in relating to others• Don’t understand facial/vocal/body cues• Joint attention- feel as if they are not

attending to you. Can’t share the moment. This is especially difficult for deaf children with Autism as they can’t attend to the object without missing the signs.

• Reciprocity• Social praise not effective as a reinforcer• Social Stories a useful tool

Behavior Differences

• Restrictive repertoire

• Prefer Routines

• Strong impulses

• Sensory issues lead to ‘melt downs’

• OCD/Perseveration

Behavior

• Problems frequently due to communication

• Difficulty with– beginning or ending activities– transitions– change

Behavior Support

• Visual tools-visual timers

• Routines/schedules

• Limit input

• Provide social training

• Direct teaching of social skills

• Adapt the environment

Deafness and Autism

• Study by Jure, Rapin, and Tuchman (New York)– 46 subjects investigated– 11 had undiagnosed autism for over four years after

the diagnosis of a hearing loss.– 10 children with autism had unrecognized hearing loss

for several years after diagnosis of autism.– Educational experience was ‘generally disastrous’

because of the late and incorrect diagnosis, and lack of specialized facilities for HI children with Autism.

Deafness and Autism

• Children with Autism may have undiagnosed hearing loss.

Taylor, Rosenblatt and Linschoten

• Studied 32 children with autism. ABR studies showed that 11 had undiagnosed moderate hearing loss, 3 had a severe to profound hearing loss.

Syndromes that Mimic a PDD

• Angelman Syndrome

• Landau-Kleffner

• Williams Syndrome

Parting Thoughts

• How can we limit social isolation?

• Placement issues

• Parental acceptance

• Behavioral “blame” - Which comes first, the deafness or the autism?

RESOURCES

• Autism Society of America

7910 Woodmont AveBethesda, MD 20814800-3-AUTISM

• Odyssey Magazine Vol 9 Issue 1 Spring/Summer 2008

• Autism Network for HI &VI Persons

Alan and Dolores Bartel7510 Oceanfront AveVirginia Beach, VA 23451

804-428-9036

• Dr. Margaret Creedon• Barbara Doyle• Walter Reese Hospital

Contact Information

Illinois Service Resource CenterServing Deaf/Hard of Hearing Student Behavioral Needs

Cheri Sinnott, Director, cheris@isrc.us

Illinois State Board of EducationIllinois Statewide Technical Assistance Center

Barbara Sims, SISEP Director bsims@isbe.net