Autism Spectrum Disorders and Deafness

1. Autism Spectrum Disordersand Deafness Illinois State Board of Education - Illinois Statewide Technical Assistance Center Illinois Service Resource Center – Serving D/HH student behavioral needs

2. Topics • Review ASD and hearing loss • Shared characteristics • Diagnosis and Intervention • Communication/ Language Acquisition • Socialization • Behavior

3. Pervasive Developmental Disorder Autistic Disorder Rett Disorder Childhood Disintegrative Disorder Asperger Disorder PDD/NOS

4. Autism is a syndrome which means it is a collection of symptoms NOT a disease

5. Autism is a disorder, ranging from mild to severe under the umbrella of pervasive developmental disorders spectrum

6. Characteristics Triad Communication Social Interaction Repetitive Activities

7. Communication - Language Skills Most InvolvedLeast 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

8. Communication - Social(verbal and non-verbal) Most InvolvedLeast Involved No overt Communicates Replies if Spontaneous, communication needs only approached but repetitive, one-sided

9. Social Interaction Most InvolvedLeast Involved Aloof and Approaches Passively Makes odd, indifferent for physical accepts one-sided needs only approaches approaches

10. Repetitive Pattern of Self-Chosen Activities Most InvolvedLeast 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)

11. SENSORY DIFFERENCES Over sensitive Under sensitive Unusual interest Emotional labile/unable to self-regulate

12. MOTOR DIFFERENCES Poor fine motor skills Clumsy Very agile Unusually good fine motor Strong motor memory

13. Cognitive Differences 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

14. ASSUME COMPETENCE! Illinois Autism/PDD Training and Technical Assistance Project

15. Hearing Loss • Mild • Moderate • Severe • Profound • Sensorineural • Conductive • Unilateral • Bilateral

18. Educational Challenges for a child with a hearing loss • Vocabulary Development • Communication options • Development of reading skills • Behavior • frustration • Social

19. 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

20. 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.)

21. 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.

22. 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 Language Development

23. Autism is NOT a rare disorder

24. nd 2 Autism is the most common developmental disorder Autism is more common than: Down Syndrome Cerebral Palsy Childhood Diabetes Cystic Fibrosis Deafness PKU All forms of childhood cancers

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

26. Number of children with autism in Illinois is increasing Numberof children with autism “counted” in Illinois has more than doubled over the last five years. Number of children with hearing loss stays steady

27. Why is ASD increasing? Variation in diagnosis/identification Greater awareness True increase

28. Centers for Disease Control Autism and Developmental Disabilities Monitoring Network (ADDM) February 2007 ASD prevalence affects approximately an average of 1 child in every 150

29. Annual Survey of Deaf and Hard of Hearing Children and Youth Gallaudet Research Institute 2006-2007 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)

30. Journal of Autism and Developmental Disorders Hearing loss occurs more often in children who have autism than in children without autism Rosenhall et al., 1999

31. When are children with ASD 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

32. How are children with ASD 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 Project

33. Evaluation Tools Childhood Autism Rating Scale Gillian Autism Rating Scale Asperger Rating Scale ADOS-Autism Diagnostic Observation Scale

34. How are children with ASD diagnosed? “Gold Standard” Autism Diagnostic Tool *ADOS (Autism Diagnostic Observation Schedule) *States not to be used with deaf children

35. How are deaf children diagnosed with ASD? There are currently NO approved instruments for diagnosing autism in a deaf child.

36. Early Diagnosis and Intervention Very Important! Inhibits development of inappropriate behavior Teaches functional communication Promotes healthy family adjustment Jacobsent, 1998/Columbia Pacific 1999

37. Early Diagnosis and Intervention Very Important! 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. Jacobsent, 1998/Columbia Pacific 1999

38. Diagnosis and Intervention • Later diagnosis makes critical early intervention less achievable • Hearing loss can mask autism • Szymanski and Brice, Odyssey Magazine, 2008

39. 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 Communication Issues

40. 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.

41. 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.

42. 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)

43. 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?

44. 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

45. Behavior Differences • Restrictive repertoire • Prefer Routines • Strong impulses • Sensory issues lead to ‘melt downs’ • OCD/Perseveration

46. Behavior • Problems frequently due to communication • Difficulty with • beginning or ending activities • transitions • change

47. Behavior Support • Visual tools-visual timers • Routines/schedules • Limit input • Provide social training • Direct teaching of social skills • Adapt the environment

48. 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.

49. 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.

50. Syndromes that Mimic a PDD • Angelman Syndrome • Landau-Kleffner • Williams Syndrome