Autism and Deafness- The Difficulties of Diagnosis Dr Rob Walker National Deaf CAMHS Central England robert.walker@dwmh.nhs.uk

More Questions than Answers

What we do know

What we don’t know – Yet??

What We Do Know (1) In children with autism the diagnosis of deafness is

often delayed

In children with deafness the diagnosis of autism is often delayed

There’s a problem- but why?

Lack of awareness and confidence

What We Do Know (2)

Autism is a behavioural diagnosis

Autism Triad

Communication Delay Deviance

Social Interaction Restricted and Repetitive Interests

Other Key Features of Autism

Anxiety

Sensory Issues

Theory of Mind Deaf children have delays in ToM

What We Do Know (3)

There is a (big) overlap between the key features of autism and the potential consequences of sensory-neural deafness

What We Do Know (4)

A diagnosis of autism can be helpful

Understanding and managing behaviour

Providing Resources

It’s important we get it right

What We Don’t Know

What causes autism

How to objectively diagnose autism

What We’re Left With

Two (main) problems Accurately diagnosing autism in deaf children

Deaf children who aren’t autistic but do have

social communication difficulties

Diagnosis (1)

Definition of deafness

Range of deafness Range of language use

Diagnosis (2)

Screening Instruments

ABC ASSQ CHAT CARS

ASSQ

27 Questions Rated No Somewhat Yes Cut offs for Parent and Teacher Versions

Problem Questions

Has a different voice or speech --------------- Has a literal understanding of ambiguous and

metaphorical language Has a deviant style of communication with a

formal, fussy, old fashioned or “robot like” language

Problem Questions (2)

Invents idiosyncratic words or expressions

Uses language freely but fails to make adjustments to fit social contexts or the needs of different listeners

Diagnosis (3)

“Diagnostic” Tools

ADI-R ADOS 3di DISCO

MDT Assessment

ADI-R Parent interview 93 Questions Rated 0-3

ADI-R Current Concerns Early Development Acquisition and Loss of Language and Other

Skills Language and Communication Social Development and Play Interests and Behaviours General Behaviours and Special Skills

Language and Communication “How much speech…” – Language - Q.29 “…if you don’t gesture”- Q.30 Articulation/ Pronunciation – Q.32 Pronominal Reversal – Q.37 Intonation/ Volume/ Rhythm/ Rate – Q.40 Attention to voice – Q.46 3-4/21 Questions

Social Development and Play Interests and Behaviour

Imitative Social Play

Sensitivity to noise

3di

Parent interview – 60 Questions

Computerised

Pros and Cons compared with ADI-R

ADOS

Autism Diagnostic Observational Schedule

4 Modules- Single Words, Phrases, Fluent Play/ Activity Based + Conversation (10-15 tasks) One Assessor plus Observers

Interpreter? Deaf Staff?

ADOS

Difficult Tasks

Demonstration Cartoons Response to name

ADOS

Scoring

Language and Communication “Vocalisation” Intonation

Reciprocal Social Interaction Response to name

Diagnosis (4)

Try to use objective measures Must be carefully interpreted

MDT Experienced in working with deaf children Deaf staff SaLT

Diagnosis (6)

Ongoing Research to validate current instruments and develop new ones

Deaf Children with Social Communication Difficulties

Group of deaf children who don’t meet diagnostic

criteria for autism but do have significant Social Communication Difficulties particularly with empathy and emotional literacy

Importance of Incidental Learning

What We Can Do Now

Avoid language deprivation

Access to spoken language and sign language

Thank You

Any (more) Questions

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