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Autism Spectrum

Research into autism spectrum disorder (ASD) in Deaf people has highlighted the importance of language role models for deaf children and the importance of diagnosticians being culturally and linguistically trained to work with Deaf people.

Although ASD is more common in deaf populations whose cause of deafness may have been associated with neurological damage, the rate of misdiagnosis in people with all types of deafness is high. Overdiagnosis may be linked to the existence of conditions that mimic ASD, which result from some deaf people experiencing poor early language environments, isolation, and poor access to information. Both over- and underdiagnosis is linked to a paucity of specialist services and specialist clinicians for deaf people.

What Is ASD?

ASD is a developmental disorder, which means that it is present from birth. Although constantly under review, the features of ASD are broadly described in three areas: social communication, obsessiveness and need for routine, and possible intellectual disability.

Social Communication

Difficulties and differences in social communication affect how a person understands the motivation or reactions of others, and they also limit a person’s ability to use and read nonverbal communication, such as body language, and the ability to empathize with others. For example, a person with ASD may stand too close to someone, fail to take turns, or be hurtfully honest. ASD may also present as a person being very concrete or literal in their interpretations. For example, when someone with ASD is told, “We will be leaving in one minute,” he or she may insist that the “one minute” be adhered to precisely.

Obsessiveness and Need for Routine

People with ASD have a severe dislike or fear of the unplanned, and they feel threatened if their routine is changed. This may present as an urgent need for order and sameness or as an obsessive interest in specific things that have a reassuring “order.” These things are often associated with symmetry, geometry, and material or cognitive predictability such as trains, spinning things, numbers, and collections of objects.

Possible Intellectual Disability

Until recently, diagnostic manuals categorized people with the aforementioned difficulties differently depending on their intelligence. Those whose intelligence was significantly lower than the national average were diagnosed as having autism, and those with intelligence in the average or above-average range were referred to as having Asperger’s syndrome or high-functioning autism. However, these two groups are now combined into the more flexible diagnosis of autism spectrum disorder.

Causes of ASD

The causes of ASD are still not fully understood. Although a genetic link has been confirmed, causal associations also exist between neurological vulnerability and ASD. When the cause of deafness threatens the functional integrity of the brain (e.g., cytomegalovirus, meningitis, rubella, prematurity, and some syndromic causes of deafness), it is not surprising to find higher rates of ASD. As survival rates for infants with these problems increase, so will the proportion of Deaf people who have ASD.

Diagnosis of ASD in Deaf People

Internationally, there is a shortage of professionals who have experience working with deaf people who have additional learning needs and even fewer who are deaf themselves or who can sign. Hence, misdiagnosis (both over- and underdiagnosis) is more common in deaf people than in an equivalent hearing population.

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