title: Autism spectrum disorders in 24 children who are deaf or hard of hearing.
abstract: OBJECTIVE
  Approximately 4% of children who are deaf or hard of hearing have co-occurring autism spectrum disorder (ASD). Making an additional diagnosis of ASD in this population can be challenging, given the complexities of determining whether speech/language and social delays can be accounted for by their hearing loss, or whether these delays might be indicative of a comorbid ASD diagnosis. This exploratory study described a population of 24 children with the dual diagnosis of ASD and hearing loss.
  
  
  METHODS
  Children completed a comprehensive ASD evaluation using standardized autism diagnostic instruments (Autism Diagnostic Observation Schedule, language and psychological testing). Children with permanent hearing loss who had a developmental evaluation between 2001 and 2011 and were diagnosed with an ASD based on the results of that evaluation were included. Information on communication modality, language and cognitive abilities was collected.
  
  
  RESULTS
  The median age of diagnosis was 14 months (range 1-71) for hearing loss and 66.5 months (range 33-106) for ASD. Only 25% (n=6) children were diagnosed with ASD ≤ 48 months of age and 46% by ≤ 6 years. Twelve (50%) children were diagnosed with ASD, 11 were diagnosed with pervasive developmental disorder not otherwise specified and 1 child had Asperger's. Most (67%) had profound degree of hearing loss. Fourteen (58%) children had received a cochlear implant, while 3 children had no amplification for hearing loss. Nine (38%) of the 24 children used speech as their mode of communication (oral communicators).
  
  
  CONCLUSIONS
  Communication delays in children who are deaf or hard of hearing are a serious matter and should not be assumed to be a direct consequence of the hearing loss. Children who received cochlear implants completed a multidisciplinary evaluation including a developmental pediatrician, which may have provided closer monitoring of speech and language progression and subsequently an earlier ASD diagnosis. Because children who are deaf or hard of hearing with ASD are challenging to evaluate, they may receive a diagnosis of ASD at older ages.
authors.affiliation: Divisions of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: jareen.meinzen-derr@cchmc.org.
authors.forename: Jareen
authors.initials: J
authors.lastname: Meinzen-Derr
authors.affiliation: Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Wiley
authors.affiliation: Department of Psychiatry, Weill-Cornell Medical College, New York, USA.
authors.forename: Somer
authors.initials: S
authors.lastname: Bishop
authors.affiliation: Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Manning-Courtney
authors.affiliation: Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Choo
authors.affiliation: Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Murray
mesh_terms: D002648:Child; D002659:Child Development Disorders, Pervasive / Q000150:complications* / Q000175:diagnosis; D002675:Child, Preschool; D003054:Cochlear Implants; D003638:Deafness / Q000150:complications* / Q000503:physiopathology; D005260:Female; D034381:Hearing Loss / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male
keywords: ASD; Autism; Deaf; Hard of hearing; Hearing loss