Sorting Out the Relative Contributions of Hearing Loss and Autism Sometimes it takes considerable detective work for a team to determine if and how much deafness alone—or another disorder such as autism—underlies a patient’s communication challenges. From the President
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From the President  |   April 01, 2016
Sorting Out the Relative Contributions of Hearing Loss and Autism
Author Notes
  • Jaynee A. Handelsman, PhD, CCC-A, is the director of pediatric audiology at the C.S. Mott Children’s Hospital and a clinical assistant professor in the Department of Otolaryngology–Head and Neck Surgery in the University of Michigan Health System. She is an affiliate of ASHA Special Interest Groups 8, Public Health Issues Related to Hearing and Balance; 9, Hearing and Hearing Disorders in Childhood; and 11, Administration and Supervision. jaynee@med.umich.edu
    Jaynee A. Handelsman, PhD, CCC-A, is the director of pediatric audiology at the C.S. Mott Children’s Hospital and a clinical assistant professor in the Department of Otolaryngology–Head and Neck Surgery in the University of Michigan Health System. She is an affiliate of ASHA Special Interest Groups 8, Public Health Issues Related to Hearing and Balance; 9, Hearing and Hearing Disorders in Childhood; and 11, Administration and Supervision. jaynee@med.umich.edu×
Article Information
Hearing Disorders / Special Populations / Autism Spectrum / From the President
From the President   |   April 01, 2016
Sorting Out the Relative Contributions of Hearing Loss and Autism
The ASHA Leader, April 2016, Vol. 21, 6-7. doi:10.1044/leader.FTP.21042016.6
The ASHA Leader, April 2016, Vol. 21, 6-7. doi:10.1044/leader.FTP.21042016.6
One of the things I have always loved about audiology is that my role is to collect puzzle pieces for an individual patient and put them together in a way that makes sense and contributes to a diagnosis. Since I enjoy puzzles of all sorts, and being around children makes me happy, working as a pediatric audiologist among a team of dedicated and talented professionals is a perfect match.
Thanks to universal newborn hearing screening and early hearing detection and intervention programs, hearing loss is being identified early and appropriate intervention is initiated quickly for the most part. When hearing is the only sensory system involved for a particular child, the process is typically fairly straightforward. Unfortunately, for many of the children we see in our clinic, hearing loss is not the only problem facing the child and his or her family.
As a result, our team members must be great detectives to sort out the relative impact of hearing loss from other issues that may contribute to a patient’s communication challenges. For example, just yesterday I performed auditory brainstem response testing on a beautiful 2-year-old who is not talking. She came to us with a presumed diagnosis of communicatively significant hearing loss in both ears. Her parents were thrilled when I told them her responses were perfectly normal bilaterally—yet eliminating hearing loss as the cause of her speech and language delay set them down a different path of questions about what else might be wrong.

Children with autism who have no hearing loss may present with hyposensitivity or hypersensitivity to sound, so obtaining accurate behavioral thresholds to auditory stimuli can be challenging.

In the case of autism, the puzzle pieces can be incredibly variable and putting them together requires the expertise of a team. For example, children with autism who have no hearing loss may present with hyposensitivity or hypersensitivity to sound, so obtaining accurate behavioral thresholds to auditory stimuli can be challenging. Children who are deaf or hard of hearing may exhibit speech and language delays that overlap with those seen in children with autism. Evidence suggests that autism is more common among children with hearing loss or vision impairment than it is among typically developing children.
Because a child may have hearing loss and autism, sorting out the relative contributions of each requires input not only from audiologists and speech-language pathologists, but also from parents, mental health professionals and educators on a team. This teamwork is essential to making appropriate diagnoses, and is even more critical in developing and implementing a treatment plan that results in each child reaching his or her full potential and achieving an optimal quality of life.
Although we have experience in our clinic with lots of children with hearing loss and autism, a subset of that group has other genetic problems associated with hearing loss—additional puzzle pieces that delay recognition of the overall picture. For example, we have a patient with CHARGE (which stands for coloboma, heart defect, atresia choanae [also known as choanal atresia], retarded growth and development, genital abnormality, and ear abnormality) syndrome who received a relatively late diagnosis of autism because initial evaluators attributed his communication problems to his hearing loss and other features of CHARGE.

Children who are deaf or hard of hearing may exhibit speech and language delays that overlap with those seen in children with autism.

Similarly, we see another young man whose diagnosis of autism was delayed because of his Down syndrome.
In both cases, a speech-language pathologist and school personnel were instrumental in recognizing features of autism in these students and bringing their concerns to the other members of the health care and educational team. Both are examples of the value of each person on the team in helping to complete the puzzle, particularly for children with multiple comorbidities.
Other articles in this issue of the Leader address new tools that clinicians can use to identify autism early, the potentially confusing overlap in symptoms between anxiety and autism, and a book by Barry Prizant that proposes a shift in thinking about autism. I look forward to hearing what the experts have to say and perhaps gaining some new insights I can apply to solving diagnostic and treatment puzzles for the patients we see in pediatric audiology. I am confident you will enjoy them as well.
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April 2016
Volume 21, Issue 4