Severe disorders of language and speech are often present in infantile autism and congenital deafness. I think autism is a variant peripheral hearing disorder, but no one else takes this theory seriously and it is taken as axiomatic that autism is due to a primary brain disorder. There is definite clinical comorbidity between autism and deafness, consistent with the otogenic theory, but also with other explanations. However, there is a simple test for elucidating this link. A deaf-autistic child should have a dramatically increased linguistic handicap over a deaf or an autistic child. In fact the two handicaps are likely to combine multiplicatively rather than additively, as in deaf-blind children whose resultant overall handicap is greater than the sum of those of blindness and deafness. My impression is that there is no extra handicap in deaf-autism over autism, consistent with these being variants of a similar underlying peripheral disorder. If this is wrong, there should be plenty in the existing literature to refute this theory, so please give examples.
why not search the Cochrane database, library it is free and evidence based summaries
"why not search the Cochrane database"
I was hoping to stimulate some thought about the relation between deafness and autism. I have checked the literature and my impression is that there is no extra handicap from deafness in autism, but this literature does not explicitly test this hypothesis and is thus indirect. Also, I am a biased observer, so would like some independent opinion. Congenital deafness is a serious linguistic handicap, so it should not be hard to find examples of it adding to overall handicap in autism as it does with all other comorbidities.
While many parents and caregivers initially confuse autism with deafness because their children do not orient toward sounds. Many individuals with autism have excellent hearing and in fact, there is a high incidence or perfect pitch among individuals with autism. While there is a high incidence of auditory disorders in autism (e.g., Doshi-Velez, F., Ge, Y., & Kohane, I. (2014). Comorbidity clusters in autism spectrum disorders: an electronic health record time-series analysis. Pediatrics, 133(1), e54-63.), these seem to be more related to processing than peripheral hearing. It is also important to remember that autism doesn't seem to be a single syndrome but rather a collection of related conditions. As a result, there may be subgroups with different causes and comorbidities.
Surely the vast number of auditory disorders on registers are of peripheral origin, albeit temporary?
As with a child presenting to a GP with suspected deafness, this must be presumed due to ear disorder until proven to the contrary. I spent many years in a specialist child audiology clinic trying desperately to find a case of central deafness. I finally found a girl I was sure had "congenital aphasia", only to discover that her sister wore a hearing aid, so I had obviously missed something!
If someone with hearing loss also has autism, surely their handicap should be severer and more obvious if these are independent conditions, so why was their autism not diagnosed any sooner (see this abstract)?
"Disabil Health J. 2013 Oct;6(4):333-42. doi: 10.1016/j.dhjo.2013.05.003. Epub 2013 Jul 25.
Childhood vision impairment, hearing loss and co-occurring autism spectrum disorder.
Kancherla V1, Van Naarden Braun K, Yeargin-Allsopp M.
BACKGROUND:
Limited population-based data on prevalence of childhood vision impairment (VI) and hearing loss (HL), and their co-occurrence with autism spectrum disorder (ASD) exists.
OBJECTIVE:
To examine prevalence and characteristics of VI, HL and co-occurring ASD among 8-year-olds in metropolitan Atlanta 2000-2008.
METHODS:
We used data from the population-based Metropolitan Atlanta Developmental Disabilities Surveillance Program. Prevalence, birth and parental characteristics, presence and severity of other co-occurring developmental disabilities, and age of earliest identification of ASD, were examined for children with VI and HL, by co-occurring ASD.
RESULTS:
VI and HL prevalences were 1.2 and 1.3 per 1000 8-year-olds, respectively. Approximately 6-7% of children with VI or HL had co-occurring ASD. Children with VI or HL with co-occurring ASD differed from those without co-occurring ASD by select birth characteristics and the presence of other co-occurring DDs. The median age of earliest known ASD diagnosis was significantly later among children with VI and ASD compared to children with ASD without VI (79 vs. 56 months). Children with HL and ASD were first evaluated by a community provider significantly earlier than those with ASD without HL (40 vs. 50 months).
CONCLUSIONS:
The frequency of co-occurring ASD with VI and HL is higher than the population prevalence of ASD. The significant delays in diagnosis of ASD in children with VI and lack of earlier diagnosis of ASD among children with HL despite earlier evaluation highlight the importance of developing screening tools for early identification of ASD among children with VI and HL."
Can I now assume that there is no evidence that peripheral deafness increases the handicap of autism?
I have now found an answer to my question in Mental Health and Deafness by Hindley & Kitson (2000):
"When the hearing impairment is in addition to an intellectual impairment there is a compounding effect referred to as 'double jeopardy' by Williams (1993). This compounding effect has been implicated in the underestimation of intellectual competence in hearing-impaired individuals.." (p 103)
"At face value it might seem that a deaf child with autism would face a greater challenge than a hearing child with autism in developing useful language. A child who avoids eye contact will surely have great difficulty acquiring a visuospatial language. Our clinical experience does not support this." (p 65)
This all clearly supports the idea that deafness and autism are two sides of the same coin.
It multiple disabilities always result in more complexity. In addition, treatment services do not typically accommodate multiple disabilities well. So the deaf child with autism or intellectual disabilities often has difficulty accessing appropriate services resulting in a secondary disadvantage. This is particularly unfortunate since hearing loss and a number of other disabilities are more common among children with developmental disabilities than in the general population.
"multiple disabilities always result in more complexity."
So it would be natural to suppose that they would inevitably result in more disability, but, as I stated in my Question: "My impression is that there is no extra handicap in deaf-autism over autism"
" So the deaf child with autism or intellectual disabilities often has difficulty accessing appropriate services resulting in a secondary disadvantage."
As I noted in my last posting, experts in the field have quite independently of myself and from a different data base, come up with the same conclusion as myself, that unlike deafness and intellectual disability, deafness and autism do not summate, they merge.
I think deafness and autism (and also learning disability) do, indeed, merge. The human strengths and failings within all differences offer plusses and minuses to their potentials which impact on relating and functioning, dependent on character, history, motivation, resilience and long-term social opportunity. I agree with a previous respondent that the overlap of necessary services to meet needs of multiple disabilities does no favours to the complex difficulties (hence complex behaviours and communications) of those Deaf people who may also have autism. The complexity of need emergent from difference in language and communication system in the case of deafness (and the possibility of deprivation at key developmental points) is further compounded by the impact of autism (and uncertain relational reciprocity at key developmental points), possibly affecting longer-term behaviour. So, long term, there is both a communication and a behavioural/social deficit which need to be supported and ameliorated, and work on emotions and behaviour is very difficult when there is a communication difference and difficulty. And changing or modifying behaviour is made more complex in those people who may enjoy repetition and routine and sameness. Clearly, peer social exchange also seems more difficult for these individuals, impacting relationships and longer-term well-being, though that is perhaps my judgement rather than theirs. However I am uncertain that this makes deafness and autism two sides of the same coin, as deaf people with learning disability without autism may enjoy peer relationships and make some functional and communication progress; those with autism too, appear to march more to their own drum.
"I think deafness and autism (and also learning disability) do, indeed, merge."
I maintain that deafness and autism are diseases/disorders of the ear, intellectual disability a brain disorder. So someone with intellectual disability is far worse off if they are also deaf or autistic. No one so far has produced evidence to suggest that deafness and autism is worse than autism alone, which, if true, would be a quick and easy way to sink my theory.
Here is a study that confirms (at least based on the abstract below) the main premise of my question, that deafness does not increase the communication disability of autism, since deafness and autism are two sides of the same coin:
Audiometric Profiles in Autism Spectrum Disorders: Does Subclinical
Hearing Loss Impact Communication?
Carly Demopoulos and Jeffrey David Lewine
Rates of hearing impairment in individuals with Autism Spectrum Disorders (ASD) are higher than those reported in the general population. Although ASD is not caused by hearing impairment, it may exacerbate symptomatology. Participants with ASD (N 5 60) and typically developing peers (N 5 16) aged 5–18 years underwent a comprehensive audiological screening (pure tone audiometry, uncomfortable loudness level, tympanometry, acoustic reflexes, distortion product otoacoustic emissions, and auditory brainstem response) and assessment of communication abilities (expressive/receptive language, articulation, phonological awareness, and vocal affect recognition). Incidence of abnormal findings on at least one measure of audiological functioning was higher for the ASD group (55%) than controls (14.9%) or the general population estimate (6%). The presence of sound sensitivity was also considerably higher for the ASD group (37%) compared with controls (0%) or general population estimates (8–15%). When participants with ASD were dichotomized into groups with and without evidence of clinical audiological abnormality, no significant differences were identified on measures of communication; however, results of correlational analyses indicated that variability in hearing thresholds at middle range frequencies (2000 Hz) was significantly related to performance on all measures of speech articulation and language after correction for multiple comparisons. These findings suggest that dichotomized classification of clinical audiology may not be sufficient to understand the role of subclinical hearing loss in ASD symptomatology and that treatment studies for mild/subclinical hearing loss in this population may be worthwhile. Autism Res 2015, 00: 000–000.
From Scottish Sensory Centre website, Univ Edinburgh, Nov 2009:
"Notes: I just wanted to highlight the complexity of a dual diagnosis
Since each of these disorders (Deafness and autism) has a profound effect on the development of language and communication, their joint effects are likely to be cumulative and devastating. Early identification of both disorders is essential in order to provide appropriate habilitation and language learning when intervention is known to be most effective. (Ruben and Rapin 1998)"
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A perfectly plausible assumption, yet which does not seem to be true. Nor has anyone here produced any such evidence in answer to this question.
Further evidence that autism does not increase the disability of autism:
Esraghi et al Otol Neurotol 2015;36:e121
"Patient #12 illustrates that well. While initially the hearing deficit masked a diagnosis of underlying autism, this patient was implanted at 3 years of age, expression scores did not improve over the following 6 years. Once autism was diagnosed, special instructional courses were pursued by the parents. The child exhibited marked learning improvement with the implant and was even implanted bilaterally at age 12. Today, this patient is high functioning and attending college with a major in chemistry."
Initially, there was no additional speech disability in those with autism and deafness compared with the non-autistic deaf control group. Autism occurred in 3% of their cochlear implant population.
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