Title: 'Considerations in Assessment of Autism Spectrum Disorder with Children who are Deaf or Hard of Hearing Children'
Track: 5 - Medical Home
Keyword(s): ASD, autism spectrum disorder, dually diagnosed, assessment, diagnosis
Learning Objectives:
  1. Describe at least two ways in which the presence of reduced hearing can delay a diagnosis of ASD when it is present.
  2. Explain a minimum of two "red flags" that ought to be considered when assessing for ASD in D/HH children.
  3. Discuss a minimum of two ways that assessments may need to be adapted when there is a question of possible ASD in D/HH children.


This presentation will highlight important considerations in the assessment of Autism Spectrum Disorder (ASD) in deaf and hard of hearing children (D/HH) by a group of professionals familiar with working with children who have been dually diagnosed. This topic is of importance given the significant implications of misdiagnosis. For example, with universal newborn hearing screening, hearing status is frequently determined early in life. As such, efforts to promote children's development are often focused on addressing issues known to commonly arise in children who are D/HH (e.g. speech-language and communication therapy – whether through the use of a signed language to promote communication skills, or through auditory training and spoken language support when assistive listening devices can be beneficial). The focus on addressing, supporting or mitigating the challenges that can be associated with reduced hearing can decrease the amount of attention given to children's other behaviors. Symptoms consistent with ASD may be overlooked or misattributed to a child's hearing loss alone. This may play a role in delaying the diagnosis of ASD, which can have a negative impact on overall development, and language and social development in particular. Research has demonstrated that earlier intervention typically yields better outcomes. This presentation will include a description of important 'red flags' to consider in guiding an assessment and will provide information on adaptations that might be necessary in the assessment process.
Presentation: Tuesday_Nunn_145_AmySzarkowski_1602.pdf

Handouts: Handout is not Available
CART: Topical Session 6- 1602.docx
Amy Szarkowski - Primary Presenter,POC
Boston Children's Hospital & Harvard Medical School
     Credentials: PhD in Clinical Psychology
     Other Affiliations: Instructor in Psychology, Department of Psychiatry, Harvard Medical School; Psychologist, Deaf and Hard of Hearing Program, Boston Children's Hospital; Adjunct Instructor at Gallaudet University & Tufts University
      Dr. Szarkowski is a Psychologist in the Deaf and Hard of Hearing Program at Boston Children's Hospital. Her work there involves conducting developmental and psychological assessments, providing support to Deaf and hard of hearing children and their families through short-term therapy, and advocating for appropriate supports and accommodations to meet childrens' needs. Dr. Szarkowski also holds an appointment as Instructor at Harvard Medical School, Department of Psychiatry. She teaches in the Deaf and Hard of Hearing Infants, Toddlers and Families Collaboration and Leadership program at Gallaudet University, as well as in the Eliot-Pearson Department of Child Study and Human Development at Tufts University.

Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.
Christine Yoshinaga-Itano - Co-Presenter
University of Colorado-Boulder
     Credentials: Ph.D., CCC-A, CED
     Other Affiliations: Marion Downs Center, Institute of Cognitive Science
      Dr. Christine Yoshinaga-Itano is a Research Professor in the Department of Speech, Language and Hearing Sciences, faculty of the Institute of Cognitive Science, Center for Neurosciences at the University of Colorado, Boulder, Department of Otolaryngology and Audiology at the University of Colorado, Denver and the Marion Downs Center. In 1996 she developed the Marion Downs National Center. Since 1996, Dr. Yoshinaga-Itano has assisted many state departments of education and public health agencies, schools for the deaf and blind, and early intervention programs throughout the United States and its territories. In addition, she has served as a consultant for many countries currently developing their early hearing detection and intervention programs, including the United Kingdom, Canada, Australia, New Zealand, Japan, China, Korea, Belgium, Poland, Spain, Austria, Denmark, Sweden, Norway, Netherlands, Mexico, Chile, Argentina, Brazil, Thailand, Philippines, and South Africa.

Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.
Susan Wiley - Co-Presenter
Cincinnati Children's Hospital Medical Center
     Credentials: M.D., Developmental Pediatrician, Professor
      Dr. Susan Wiley is a developmental pediatrician with expertise in children who are deaf/hard of hearing. She has many years of experience serving children with multiple disabilities.

Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.
Deborah Mood - Author
Colorado Children's Hospital
     Credentials: PhD
      Dr. Mood is a psychologist who has worked with children who are deaf/hh with co-existing developmental disabilities.