Autism and Hearing Loss in Children

One in 59 children with hearing loss also has autism spectrum disorder (ASD). It can be difficult for parents to distinguish these problems from each other. In some instances, children with autism are misdiagnosed as deaf due to overlapping behaviors and symptoms of the two conditions.

It's important to recognize the signs of ASD and hearing loss and to get your child evaluated. Early intervention can make a difference in your child's quality of life.

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Signs of Hearing Loss

Some children may have congenital (at birth) hearing impairment, and hearing loss can also develop during childhood. As a parent, you may notice signs of hearing problems even if your child does not complain that they can't hear.

Signs can include:

  • Not reacting to noises
  • Speech delay
  • Consistently mispronounces words
  • Seems to ignore you or others who are talking to them
  • Behavioral problems at home or school
  • Uses entertainment or other devices at a high volume

If your child has any of these problems, make an appointment to see their pediatrician and discuss your concerns.

Signs of Autism

Autism is a complex condition that can cause a variety of symptoms, including behavioral problems, communication difficulties, emotional problems, and sometimes a fixation with repetitive behaviors.

Behaviors that Mimic Hearing Loss

Children who have autism can behave similarly to children who have a hearing impairment. These issues are especially noticeable in their interactions with others.

Similar characteristics include:

  • Lack of normal eye contact: Many children who have ASD avoid eye contact. Children who have hearing problems might look at you when they know you are speaking to them, but they might not turn to look at you if they don't know you are trying to get their attention.
  • Echolalia: Children who have hearing impairment may repeat words to try to understand them, and children who have ASD might repeat words as a behavioral pattern.
  • Delayed language: Children who have ASD have a hard time with verbal and nonverbal language development, while children who can't hear well might have difficulty hearing and reproducing the sounds.
  • Delayed social skills: Children who are hard of hearing may have trouble communicating, while children who have ASD may have a range of social difficulties, from awkwardness to frustration and unusual behavior.
  • Social isolation: The frustration or sadness caused by communication difficulties can cause a child who has a hearing impairment to avoid others, while children who have ASD may become stressed and agitated when around people.

There is an overlap between childhood behaviors in autism and behaviors with hearing loss, so it can be hard to distinguish the conditions.

Autism with Hearing Loss

Children who have hearing loss have a higher-than-average incidence of developmental delay, including autism—although the exact increase in risk is not known. If your child has been diagnosed with hearing loss based on objective tests, you might also notice behavioral symptoms that are not exactly what you were told to expect in association with their hearing loss.

Signs of autism or another developmental issue could include:

  • A lack of interest in other people
  • Lack of acknowledgment of facial expressions
  • Abnormal emotions and emotional expressions
  • An unusual fixation on repetitive tasks that don't necessarily advance their skills, like throwing a ball the same exact way without learning how to play the sport
  • Cognitive delay
  • Agitation, irritability
  • Repetitive movements, like rocking or head-banging

Talk to your child's doctor about their behavior and whether an evaluation beyond their hearing deficit might be needed.

Hearing loss in children can be associated with genetic causes or developmental issues, including autism. Hearing problems in autism can have a variety of specific causes, including structural issues.

While there is an association between the conditions, children can have both hearing loss and autism without a specific association between the conditions. For example, a child who has autism can also develop hearing loss after an inner ear infection or due to head trauma.

Diagnosis

Sometimes autism is misdiagnosed as hearing loss, or one of these conditions is diagnosed before the other. Healthcare professionals are aware of the similarities and may screen for one condition due to the presence of the other.

However, your child might not have hearing loss at the time of their autism diagnosis, or might not have signs of autism when they are diagnosed with hearing loss, so additional testing as they get older can be helpful.

Hearing Tests

A newborn hearing test can detect a baby's response to certain noises. Additionally, screening tests that can detect early signs of hearing loss are commonly scheduled at regular intervals in many preschools and elementary schools. If your child has had a school hearing test, try to get the results and bring them with you to their doctor's visit,

If there is a concern, your child's doctor may also do additional testing, such as:

If your child has a hearing deficit, their medical care may involve an interdisciplinary team.

  • An audiologist is a specialist trained in evaluating hearing loss.
  • A neurologist is a specialist who can diagnose and treat neurological diseases that may contribute to hearing loss.
  • An ear, nose, and throat doctor may treat hearing loss related to structural issues.
  • A speech therapist can help your child learn to communicate.

Autism Diagnosis

There are several tests used to help diagnose autism, although there is no definitive test that confirms the diagnosis.

The Autism Diagnostic Observation Schedule is among the tests used in the diagnosis of autism. For children who have hearing loss, the test can be adapted by using sign language.

Other diagnostic tests used in the evaluation of autism, such as the Autism Diagnostic Interview-Revised (ADI-R), may also be adapted with visual tools to help determine whether a child has ASD, hearing loss, or both.

Treatments and Intervention Services

If your child is diagnosed with a hearing deficit and/or ASD, they will need intervention for each condition that they have. Some treatments may need to be modified to accommodate the other diagnosis.

Treatment for Deafness

There are many types of hearing loss that can occur with autism. Hearing loss in children can be partial or complete, and it may involve one or both ears. Additionally, the problem may be progressive or it could be stable.

Treatments for hearing impairment involve consideration of the cause. For example, children who have recurrent ear infections may need ear tubes placed. Children who have structural issues may need surgery, such as cochlear implants. And some children may need to use a hearing aid.

Treatment for Autism

If your child has autism, there are a number of interventions they may need.

Treatments for ASD can include:

These treatment approaches may need to be modified if your child also has a hearing deficit. Visual tools, sign language, and gestures may be helpful as your child works with their therapist.

A Word From Verywell

Early intervention is beneficial for managing hearing loss in children and for managing autism. Parents also are impacted by the dual diagnosis, and it is important that you reach out for help in managing your own stress as you cope with the challenges of caring for your child.

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