Title: 'Communication Outcomes for Children with Cochlear Implants and Autism Spectrum Disorder'
Track: 3 - Language Acquisition and Development
Keyword(s): Cochlear Implants, Autism, Communication Mode
Learning Objectives:
  1. Attendees will identify the red flags for ASD in children with hearing loss.
  2. Attendees will understand that communication expectations for children with hearing loss and ASD may need to be modified.
  3. Attendees will understand the necessity of integrating multiple communication approaches as soon as red flags are evident in order to improve functional communication (e.g. independently communicate needs and wants).


Autism Spectrum Disorder (ASD) and significant hearing loss negatively impact a child’s functional communication. Research indicates that co-occurring diagnosis of ASD and hearing loss is increasing. Universal newborn hearing screening has lead to earlier diagnosis of hearing loss resulting in an increased number of children receiving cochlear implants before 18 months of age. Reliable diagnosis of ASD typically occurs during the preschool years for hearing children but later for children with hearing loss. Given these facts, a diagnosis of hearing loss and possible cochlear implantation will likely occur prior to a diagnosis of ASD. This poses particular challenges for clinicians working with children who have this dual diagnosis due to their complex communication needs. A retrospective chart review of children with cochlear implants and an ASD diagnosis within our center was conducted. Each child’s chart was reviewed for: 1) age of diagnosis of hearing loss; 2) age of cochlear implantation(s); 3) age of ASD diagnosis; 4) early intervention/educational history; 5) communication approaches explored; and 6) child’s current communication modality(s). Chart reviews indicate that 90% of the children currently utilize a combination of communication modalities. Seventy percent of children initially used a single communication system, but over time additional modalities were introduced to increase functional communication. The dual diagnosis of hearing loss and ASD impacts the communication development of children. This case review indicated that children with a dual diagnosis will most likely use a variety of modalities to communicate. As this population of children increases it is imperative that clinicians: recognize the early indicators of ASD in children with hearing loss; be knowledgeable about a wide range of appropriate modalities; be flexible with teaching strategies; and counsel the child’s family regarding using a variety of communication approaches.
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Terra Boulse-Archaro - Primary Presenter,POC
Seattle Children's Hospital
     Credentials: MA, CCC-SLP
      Terra L. Boulse – Archaro, MA, CCC-SLP, serves as an aural habilitation specialist at Seattle Children’s Hospital. As a member of the Cochlear Implant and Hearing Loss Clinic team, she conducts evaluations, performs therapy, and is the co-leader of a social skills group for children/teens with hearing loss. Terra has 15 years experience working as a speech – language pathologist in the public schools, pediatric hospital setting, and private practice clinics, specifically working with children with hearing loss, autism, and multiple diagnoses. She also has served as a clinical supervisor and lecturer at the University of Northern Colorado and the University of Washington. Terra received her Master’s degree in Speech – Language Pathology from Truman State University.

Financial - Receives Salary for Employment from Seattle Children's Hospital.  

Nonfinancial - No relevant nonfinancial relationship exist.